Provider Demographics
NPI:1386604221
Name:FISCH, JAMES M
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:FISCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S MICHIGAN AVE
Mailing Address - Street 2:RM. 1321A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-6191
Mailing Address - Country:US
Mailing Address - Phone:312-922-1455
Mailing Address - Fax:847-835-0337
Practice Address - Street 1:122 S MICHIGAN AVE
Practice Address - Street 2:RM. 1321A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-6191
Practice Address - Country:US
Practice Address - Phone:312-922-1455
Practice Address - Fax:847-835-0337
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG62599Medicare UPIN
407030Medicare ID - Type Unspecified