Provider Demographics
NPI:1932376993
Name:JEFREY FISHMAN, M.D. P.C.
Entity type:Organization
Organization Name:JEFREY FISHMAN, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFREY
Authorized Official - Middle Name:RALPH-ALAN
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-643-7374
Mailing Address - Street 1:1777 AXTELL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4435
Mailing Address - Country:US
Mailing Address - Phone:248-643-7374
Mailing Address - Fax:248-643-4715
Practice Address - Street 1:1777 AXTELL DR STE 200
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4435
Practice Address - Country:US
Practice Address - Phone:248-643-7374
Practice Address - Fax:248-643-4715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF01721Medicare UPIN