Provider Demographics
NPI:1588660815
Name:FISCHER, MICHAEL JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:FISCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2043
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-2043
Mailing Address - Country:US
Mailing Address - Phone:775-882-2988
Mailing Address - Fax:775-882-1726
Practice Address - Street 1:3839 N CARSON ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-1935
Practice Address - Country:US
Practice Address - Phone:775-882-2988
Practice Address - Fax:775-882-1726
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2010-11-05
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
NV4831207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002013384Medicaid
NVC96029Medicare UPIN
NV002013384Medicaid