Provider Demographics
NPI:1144021635
Name:FISCHER, DEREK (RD)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:
Last Name:FISCHER
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 GARDNER POND LN
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49097-7785
Mailing Address - Country:US
Mailing Address - Phone:269-341-7554
Mailing Address - Fax:
Practice Address - Street 1:601 JOHN ST STE W-308
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5357
Practice Address - Country:US
Practice Address - Phone:269-341-7554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered