Provider Demographics
NPI:1780781021
Name:FISH, ALFRED J (MD)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:J
Last Name:FISH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE ST SE MMC 491
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-6777
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:516 DELAWARE ST SE PWB FOURTH FLOOR, ROOM 4-100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN188092080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0052088Medicaid
MN2T277FIOtherBCBS
IA0990382Medicaid
MN31-22593OtherMEDICA-CHOICE
768114OtherARAZ
MN1010277OtherPREFERRED ONE
MN101070OtherUCARE
MN3174530OtherMEDICA-PRIMARY
MNHP13287OtherHEALTH PARTNERS
MN050401OtherFAIRVIEW
MNHP13287OtherHEALTH PARTNERS