Michael Fish PHD PA

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY3726 Issued in FL

Legal business name

MICHAEL FISH PHD PA

Practice address

10200 W State Road 84 Ste 105
Davie, FL 33324-4218

Phone

(954) 370-7692

Fax

(954) 370-2383

NPI assigned

Nov 6, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael Fish, PH.D.NPI 1548358294

Title

President/Psychologist

Phone

(954) 370-7692

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Fish, PH.D.

  • Psychologist
  • Davie, FL
  • NPI 1548358294
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507507200000",
    "number": "1376723478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1304 SW 160TH AVE",
            "address_2": "SUITE 339",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333261902",
            "telephone_number": "954-370-7692",
            "fax_number": "954-370-2383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10200 W STATE ROAD 84 STE 105",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333244218",
            "telephone_number": "954-370-7692",
            "fax_number": "954-370-2383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL FISH PHD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-06",
        "last_updated": "2017-10-09",
        "status": "A",
        "authorized_official_last_name": "FISH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT/PSYCHOLOGIST",
        "authorized_official_telephone_number": "954-370-7692",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY3726",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "73683",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS/TRICARE",
            "identifier": "056610",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Davie, FL
• Providers in Davie, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.