Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 013561 | MI |
N | 213EG0000X | General Practice | 013561 | MI |
N | 122400000X | Denturist | 013561 | MI |
NPI | 1457427106 |
---|---|
Provider Name | Brian R Fisher |
First Address | Traverse City, MI 49686 |
Second Address | Traverse City, MI 49686 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2006 |
Last Update Date | 08/07/2007 |