Provider Demographics
NPI:1932736816
Name:FISHER, TAYLOR EVAN (PA)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:EVAN
Last Name:FISHER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 N SHERIDAN RD APT 301
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5578
Mailing Address - Country:US
Mailing Address - Phone:312-402-8815
Mailing Address - Fax:
Practice Address - Street 1:1140 N STATE ST
Practice Address - Street 2:
Practice Address - City:SAINT IGNACE
Practice Address - State:MI
Practice Address - Zip Code:49781-1048
Practice Address - Country:US
Practice Address - Phone:906-643-8585
Practice Address - Fax:906-643-0461
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
MI5601010463363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant