Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | ME25700 | FL |
Y | 111NI0900X | Internist | ME25700 | FL |
N | 207RA0201X | Internist - Allergy & Immunology | ME25700 | FL |
NPI | 1255314365 |
---|---|
Provider Name | Charles Michael Fischman |
First Address | Vero Beach, FL 32961-0038 |
Second Address | Vero Beach, FL 32960-4508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 29/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
065438800 | (05) | FL |
D60150 | (02) | FL |