Individual provider Active NPI

Laurie K Fisher, MD

  • Pediatrics Physician
  • West Bloomfield, MI
National Provider Identifier
1629030929
Registry record updated Dec 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
4301051426 Issued in MI
Practice address
6900 Orchard Lake Rd
Ste 206
West Bloomfield, MI 48322
Phone
(248) 855-7510
Fax
(248) 855-5626
NPI assigned
Apr 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 4301051426 MI Primary

Addresses

Primary practice location

6900 Orchard Lake Rd
Ste 206
West Bloomfield, MI 48322

Mailing address

6900 Orchard Lake Rd
Ste 206
West Bloomfield, MI 48322
Phone (248) 855-7510

Other identifiers 1

IdentifierTypeStateIssuer
312673010MedicaidMI

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301051426MIMDPediatrics Physician

NPI Registry JSON

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

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322697600000",
    "number": "1629030929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6900 ORCHARD LAKE RD",
            "address_2": "STE 206",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "48322",
            "telephone_number": "248-855-7510",
            "fax_number": "248-855-5626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 ORCHARD LAKE RD",
            "address_2": "STE 206",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "48322",
            "telephone_number": "248-855-7510",
            "fax_number": "248-855-5626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISHER",
        "first_name": "LAURIE",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-04",
        "last_updated": "2011-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301051426",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "312673010",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Bloomfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.