Provider Demographics
NPI:1619053469
Name:FISCHER, ROBIN M (PA)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:M
Last Name:FISCHER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:M
Other - Last Name:TANGY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:52 CARLYLE LN
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6696
Mailing Address - Country:US
Mailing Address - Phone:630-965-3014
Mailing Address - Fax:
Practice Address - Street 1:900 W IL ROUTE 22 STE 100
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-3416
Practice Address - Country:US
Practice Address - Phone:847-462-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-001299363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILS90531Medicare UPIN