Provider Demographics
NPI:1477676724
Name:JONATHAN A. FISCH, MD, PC
Entity type:Organization
Organization Name:JONATHAN A. FISCH, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:FISCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-872-0646
Mailing Address - Street 1:8330 NAAB ROAD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260
Mailing Address - Country:US
Mailing Address - Phone:317-872-0646
Mailing Address - Fax:317-872-4339
Practice Address - Street 1:8330 NAAB RD
Practice Address - Street 2:SUITE 302
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5925
Practice Address - Country:US
Practice Address - Phone:317-872-0646
Practice Address - Fax:317-872-4339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024317A207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative MedicineGroup - Single Specialty