Provider Demographics
NPI:1801841507
Name:FISCHER, JOHN R (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
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:PO BOX 55114
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48255
Mailing Address - Country:US
Mailing Address - Phone:248-858-3197
Mailing Address - Fax:248-858-3148
Practice Address - Street 1:44405 WOODWARD AVENUE
Practice Address - Street 2:ST JOSEPH MERCY HOSPITAL
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-2985
Practice Address - Country:US
Practice Address - Phone:248-858-3190
Practice Address - Fax:248-858-3148
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI054499207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3018161Medicaid
MI3018161Medicaid
E19847Medicare UPIN