Provider Demographics
NPI:1841214061
Name:FISHER, ROBERT H (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:FISHER
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 1:350W GREEN TREE RD 200
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3815
Mailing Address - Country:US
Mailing Address - Phone:414-352-0084
Mailing Address - Fax:414-352-0083
Practice Address - Street 1:350 W GREEN TREE RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217
Practice Address - Country:US
Practice Address - Phone:262-784-5431
Practice Address - Fax:414-352-0083
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34325-020207RA0201X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0557326OtherCIGNA
3920328241071690OtherUNITED HEALTHCARE
WIP00308927OtherMEDICARE RAILROAD
WI31925700Medicaid
392032824OtherWEA
4638942OtherAETNA
WI68099Medicare ID - Type Unspecified
WI0126-68655Medicare ID - Type Unspecified
WI01021Medicare ID - Type Unspecified
3920328241071690OtherUNITED HEALTHCARE