Provider Demographics
NPI:1891771440
Name:FISCHELL, TIM ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:ALEXANDER
Last Name:FISCHELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1722 SHAFFER ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1633
Mailing Address - Country:US
Mailing Address - Phone:269-381-3963
Mailing Address - Fax:269-381-2809
Practice Address - Street 1:1722 SHAFFER ST
Practice Address - Street 2:SUITE 1
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1633
Practice Address - Country:US
Practice Address - Phone:269-381-3963
Practice Address - Fax:269-381-2809
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301068581207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3265770Medicaid
MIF08510Medicare UPIN