Provider Demographics
NPI:1912991787
Name:FISHER, MICHAEL D (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:FISHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9998 CROSSPOINT BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3307
Mailing Address - Country:US
Mailing Address - Phone:317-579-2150
Mailing Address - Fax:317-579-2130
Practice Address - Street 1:9998 CROSSPOINT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3307
Practice Address - Country:US
Practice Address - Phone:317-579-2150
Practice Address - Fax:317-579-2130
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10360802085R0202X
IN01036080A2085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00032807OtherRAILROAD MEDICARE
INP00033052OtherRAILROAD MEDICARE
INP00032826OtherRAILROAD MEDICARE
IN000000203089OtherANTHEM
INP00032844OtherRAILROAD MEDICARE
IN200044380AMedicaid
IN300123636OtherRAILROAD MEDICARE
INP00032631OtherRAILROAD MEDICARE
INP00032644OtherRAILROAD MEDICARE
INP00033107OtherRAILROAD MEDICARE
INP00032761OtherRAILROAD MEDICARE
INP00033227OtherRAILROAD MEDICARE
INP00033228OtherRAILROAD MEDICARE
INP00033262OtherRAILROAD MEDICARE
INP00363050OtherRAILROAD MEDICARE
IN200044380AMedicaid
INP00032807OtherRAILROAD MEDICARE
INP00032826OtherRAILROAD MEDICARE
IN822400CCMedicare PIN
INP00033052OtherRAILROAD MEDICARE
IN151560BBMedicare PIN