Provider Demographics
NPI:1427073543
Name:FISHER, THOMAS LEE SR (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LEE
Last Name:FISHER
Suffix:SR
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 1:47 W POLK ST LBBY G1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2087
Mailing Address - Country:US
Mailing Address - Phone:312-922-3011
Mailing Address - Fax:312-922-5875
Practice Address - Street 1:47 W POLK ST LBBY G1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2087
Practice Address - Country:US
Practice Address - Phone:312-922-3011
Practice Address - Fax:312-922-5875
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-043966207ND0900X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036--043966Medicaid
D12320Medicare UPIN
IL036--043966Medicaid