Provider Demographics
NPI:1396759775
Name:FISCH, GARY R (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:R
Last Name:FISCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11725 N ILLINOIS ST
Practice Address - Street 2:SUITE 265
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3015
Practice Address - Country:US
Practice Address - Phone:317-688-5100
Practice Address - Fax:317-688-5111
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025668A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100066370Medicaid
IN264430075Medicare PIN
IN218650JMedicare PIN
IN100066370Medicaid
INM400061616Medicare PIN
B95775Medicare UPIN