Provider Demographics
NPI:1740381862
Name:FISCHER, JOHN CARMON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CARMON
Last Name:FISCHER
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 1:10832 SPARKLING WATERS CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-9494
Mailing Address - Country:US
Mailing Address - Phone:517-404-4337
Mailing Address - Fax:248-661-6468
Practice Address - Street 1:6777 W MAPLE RD
Practice Address - Street 2:HENRY FORD HEALTH SYSTEM CARDIOLOGY
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3013
Practice Address - Country:US
Practice Address - Phone:248-661-6461
Practice Address - Fax:248-661-6468
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI43027601282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI060H26441Medicare ID - Type Unspecified
MIE19792Medicare UPIN