Provider Demographics
NPI:1780692905
Name:FISHER, MARC L (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:L
Last Name:FISHER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:352 BROWN BLVD
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2458
Mailing Address - Country:US
Mailing Address - Phone:815-932-2020
Mailing Address - Fax:815-937-0060
Practice Address - Street 1:352 BROWN BLVD
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2458
Practice Address - Country:US
Practice Address - Phone:815-932-2020
Practice Address - Fax:815-937-0060
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2013-03-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036066141207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD15177Medicare UPIN