Provider Demographics
NPI:1902828197
Name:FISHER, IAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:M
Last Name:FISHER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1126 S 70TH ST
Mailing Address - Street 2:#N500
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214
Mailing Address - Country:US
Mailing Address - Phone:414-455-4780
Mailing Address - Fax:414-475-2936
Practice Address - Street 1:820 E TERRA COTTA AVE
Practice Address - Street 2:#129 136 OPEN ADVANCED MRI OF CRYSTAL LAKE LLC
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014
Practice Address - Country:US
Practice Address - Phone:815-444-1330
Practice Address - Fax:815-444-1249
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-02-25
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Provider Licenses
StateLicense IDTaxonomies
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I63758Medicare UPIN