Michael Shaun Fisher – Home Modifications Contractor

Key facts

NPI: 1093586281
Entity type: Individual (NPI type 1)
Primary specialty: Home Modifications Contractor 171WH0202X
License: 320900000X (MO)
Practice address: 1335 Redwood Dr
Saint Clair, MO 63077-2018
Phone: (636) 358-3019
NPI assigned: Jan 16, 2024
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Elite Access & Renovations, LLC Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Saint Clair, MO · NPI 1710739628

NPD Authorized official

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
320900000X	MO	MD	Home Modifications Contractor

Practice roles

Organization	Specialty	Status	New patients
Elite Access & Renovations, LLC		Current since Apr 9, 2024	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Home Modifications Contractor	171WH0202X	320900000X	MO	Yes

Addresses

Primary practice location

1335 Redwood Dr
Saint Clair, MO 63077-2018

Mailing address

1335 Redwood Dr
Saint Clair, MO 63077-2018
Phone (636) 358-3019

Other providers in Saint Clair, MO

All providers in Saint Clair, MO · Home Modifications Contractor in Missouri

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.