Provider Demographics
NPI:1982753653
Name:FISCHER, BARRY LAKE (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:LAKE
Last Name:FISCHER
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 1:121 FAIRFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1588
Mailing Address - Country:US
Mailing Address - Phone:630-529-7427
Mailing Address - Fax:630-529-9937
Practice Address - Street 1:535 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3938
Practice Address - Country:US
Practice Address - Phone:630-548-5936
Practice Address - Fax:630-548-5940
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036060013207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine