Provider Demographics
NPI:1144238593
Name:FISHMAN, JEFREY RALPH-ALAN (MD)
Entity type:Individual
Prefix:
First Name:JEFREY
Middle Name:RALPH-ALAN
Last Name:FISHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 AXTELL
Mailing Address - Street 2:SUITE 109
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084
Mailing Address - Country:US
Mailing Address - Phone:248-643-7374
Mailing Address - Fax:248-643-4715
Practice Address - Street 1:1777 AXTELL
Practice Address - Street 2:SUITE 109
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084
Practice Address - Country:US
Practice Address - Phone:248-643-7374
Practice Address - Fax:248-643-4715
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJF0481092082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI06368708241Medicare ID - Type Unspecified
F01721Medicare UPIN