Provider Demographics
NPI:1679976906
Name:MICHAEL FISHMAN DPM INC
Entity Type:Organization
Organization Name:MICHAEL FISHMAN DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:562-431-2558
Mailing Address - Street 1:3851 KATELLA AVE
Mailing Address - Street 2:SUITE 355
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3377
Mailing Address - Country:US
Mailing Address - Phone:562-431-2558
Mailing Address - Fax:562-296-8389
Practice Address - Street 1:3851 KATELLA AVE
Practice Address - Street 2:SUITE 355
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3377
Practice Address - Country:US
Practice Address - Phone:562-431-2558
Practice Address - Fax:562-596-5703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4874213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty