Provider Demographics
NPI:1205888773
Name:FISCHER, CAROL MARIAM (DO)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:MARIAM
Last Name:FISCHER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1030 HARRINGTON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2967
Mailing Address - Country:US
Mailing Address - Phone:586-493-3880
Mailing Address - Fax:586-493-3883
Practice Address - Street 1:1030 HARRINGTON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2967
Practice Address - Country:US
Practice Address - Phone:586-493-3880
Practice Address - Fax:586-493-3883
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2019-07-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101015319207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP51040001Medicare PIN