Provider Demographics
NPI:1336990795
Name:FISHER PEDIATRICS LLC
Entity type:Organization
Organization Name:FISHER PEDIATRICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-490-6494
Mailing Address - Street 1:9719 TREVIA DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-7203
Mailing Address - Country:US
Mailing Address - Phone:317-490-6494
Mailing Address - Fax:
Practice Address - Street 1:4037 ARBOR LN STE D
Practice Address - Street 2:
Practice Address - City:NEW PALESTINE
Practice Address - State:IN
Practice Address - Zip Code:46163-9269
Practice Address - Country:US
Practice Address - Phone:317-861-7125
Practice Address - Fax:317-861-7141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty