Provider Demographics
NPI:1386207702
Name:FISHER, ALEC HAYES
Entity type:Individual
Prefix:
First Name:ALEC
Middle Name:HAYES
Last Name:FISHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 RIVERSIDE DR STE 2700
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-5071
Mailing Address - Country:US
Mailing Address - Phone:779-701-2762
Mailing Address - Fax:779-701-2765
Practice Address - Street 1:300 RIVERSIDE DR STE 2700
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-5071
Practice Address - Country:US
Practice Address - Phone:779-701-2762
Practice Address - Fax:779-701-2765
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361743522086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery