Provider Demographics
NPI:1174704985
Name:CAROL M FISCHER DO PLLC
Entity type:Organization
Organization Name:CAROL M FISCHER DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER/ OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GRALESKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-493-3880
Mailing Address - Street 1:1030 HARRINGTON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2967
Mailing Address - Country:US
Mailing Address - Phone:586-493-3880
Mailing Address - Fax:586-493-3883
Practice Address - Street 1:1030 HARRINGTON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2967
Practice Address - Country:US
Practice Address - Phone:586-493-3880
Practice Address - Fax:586-493-3883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015319261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP51040Medicare PIN