Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036059573 | IL |
N | 207XS0117X | Orthopaedic Spine Surgeon | 036059573 | IL |
NPI | 1174631188 |
---|---|
Provider Name | Dr. James S Fister |
First Address | Elgin, IL 60123-4719 |
Second Address | Elgin, IL 60123-4719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 01/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036059573 | (05) | IL |
200015630 | RR MEDICARE (01) | |
207906 | MEDICARE GRP-MCH (01) | |
208821 | MEDICARE GRP KANE (01) | |
C46083 | (02) | |
CE6001 | RR MEDICARE GRP-KANE CTY (01) | |
CG2631 | RR MEDICARE GRP-MCHENRY C (01) |