Provider Demographics
NPI:1750685640
Name:FISCHER, KEITH
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:FISCHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 AMERICAN BLVD W
Mailing Address - Street 2:SUITE 945
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-1108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5001 AMERICAN BLVD W
Practice Address - Street 2:SUITE 945
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-1108
Practice Address - Country:US
Practice Address - Phone:952-835-6653
Practice Address - Fax:952-835-3895
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist