Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 016004411 | IL |
Y | 222Z00000X | Podiatrist | 016004411 | IL |
NPI | 1023164100 |
---|---|
Provider Name | Dr. Denise Fischer |
First Address | Danville, IL 61832-3741 |
Second Address | Danville, IL 61832-3741 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 29/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016004411 | (05) | IL |
T87066 | (02) | IL |