Provider Demographics
NPI:1720271596
Name:FISHER, MICHAEL ANTHONY
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:FISHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 MILL ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-3059
Mailing Address - Country:US
Mailing Address - Phone:614-472-0092
Mailing Address - Fax:614-472-0094
Practice Address - Street 1:136 MILL ST
Practice Address - Street 2:SUITE 120
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3059
Practice Address - Country:US
Practice Address - Phone:614-472-0092
Practice Address - Fax:614-472-0094
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11804074OtherCAQH
OH000000541536OtherANTHEM BC BS
OH2956225Medicaid
OH11804074OtherCAQH