Provider Demographics
NPI:1639317696
Name:BISHKO, FREDERIC CARL (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:CARL
Last Name:BISHKO
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 1:2679 ROCKLYN RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-2112
Mailing Address - Country:US
Mailing Address - Phone:216-831-0390
Mailing Address - Fax:216-464-3929
Practice Address - Street 1:2679 ROCKLYN RD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-2112
Practice Address - Country:US
Practice Address - Phone:216-831-0390
Practice Address - Fax:216-464-3929
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35. 028342207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology