Provider Demographics
NPI:1659447027
Name:FISCHMAN, MICHAEL LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LAWRENCE
Last Name:FISCHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1270 ARROYO WAY
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4216
Mailing Address - Country:US
Mailing Address - Phone:925-283-2366
Mailing Address - Fax:925-283-3275
Practice Address - Street 1:1270 ARROYO WAY
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4216
Practice Address - Country:US
Practice Address - Phone:925-283-2366
Practice Address - Fax:925-283-3275
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43377207R00000X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G433770Medicaid
CA00G433770Medicaid
CAA49328Medicare UPIN