Provider Demographics
NPI:1710941331
Name:FISHER, CURTIS WILLIAM II (DO)
Entity Type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:WILLIAM
Last Name:FISHER
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 BROADWAY ST STE B
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-3905
Mailing Address - Country:US
Mailing Address - Phone:309-349-8700
Mailing Address - Fax:309-349-8701
Practice Address - Street 1:2401 BROADWAY ST STE B
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-3905
Practice Address - Country:US
Practice Address - Phone:309-349-8700
Practice Address - Fax:309-349-8701
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-070261207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK26535Medicare ID - Type Unspecified
E72021Medicare UPIN