Larry Alan Fisher, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019-015484 Issued in IL

Practice address

1945 W Wilson Ave
Suite 2112
Chicago, IL 60640-5255

Phone

(773) 561-4508

Fax

(773) 561-4508

NPI assigned

Oct 31, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219881600000",
    "number": "1639160658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1945 W WILSON AVE",
            "address_2": "SUITE 2112",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405255",
            "telephone_number": "773-561-4508",
            "fax_number": "773-561-4508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1945 W WILSON AVE",
            "address_2": "SUITE 2112",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405255",
            "telephone_number": "773-561-4508",
            "fax_number": "773-561-4508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISHER",
        "first_name": "LARRY",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-31",
        "last_updated": "2008-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-015484",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164971",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erin Fisher, MSW
• Harriet Fisher
• Kathleen Mary Fisher, APN MS CCRN CCNS
• Kayla Marie Fisher
• Kristen Margaret Fisher, APRN
• Lindsay Fisher, DMD
• Marquette Fisher
• Michael Fisher, MSW
• Natea Fisher
• Raymond Fisher, M.D.

• All providers in Chicago, IL
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.