DR. JEREMY G FISK (NPI# 1174788780) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174788780 |
| Entity Type | Individual |
| Full Name | DR. JEREMY G FISK |
| Credential | MD |
| Practice Address |
509 N Peru St Cicero IN 46034-9499 |
| Mailing Address |
Po Box 775985 Chicago IL 60677-5985 |
| Practice Telephone | 3179849311 |
| Practice Fax Number | 3179847302 |
| Mailing Telephone | 3177706911 |
| Mailing Fax Number | 3177706911 |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2020-09-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 01066942A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200977870 | 05 |
| Street Address |
509 N PERU ST |
| City | CICERO |
| State | IN |
| Zip Code | 46034-9499 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558348896 | Charles R Harris | Family Medicine | 509 N Peru St, Cicero, IN 46034-9499 | 2005-12-28 |
| 1003215047 | David Henry | Physician Assistant | 509 N Peru St, Cicero, IN 46034-9499 | 2014-08-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548486905 | Mark R Montgomery | Dentist | 130 W Jackson St, Cicero, IN 46034 | 2007-04-17 |
| 1689710170 | Thomas Jerry Elliott Sr. | Dentist | 17 West Jackson St., Cicero, IN 46034 | 2007-01-30 |
| 1144285719 | Mary Angela Shirley | Social Worker | 209 S Peru St, Ste 210-211, Cicero, IN 46034 | 2006-04-18 |
| 1164486601 | Nancy Leah Shirley | Social Worker | 209 S Peru Street, Suite 210 211, Cicero, IN 46034 | 2006-04-13 |
| 1700867827 | Richard Edward Hayes | Family Medicine | 1160 S. Peru Street, S.r. 19, Cicero, IN 46034 | 2005-11-07 |
| 1306251897 | Jon Purkey | Specialist/Technologist | 230 Washington Avenue, Cicero, IN 46034-0321 | 2014-06-24 |
| 1477836070 | Myrtie B Mays | Specialist | 22345 Schulley Rd, Cicero, IN 46034-8800 | 2011-09-21 |
| 1609002724 | Hoosier Dentures & Dental Surgery, LLC | Clinic/Center | 1200 S Peru St, Cicero, IN 46034-9161 | 2009-06-03 |
| 1710549142 | Julie Baber | Technician | 1180 Coral Springs Dr, Cicero, IN 46034-9214 | 2019-07-05 |
| 1669592572 | Shelley Kunkel | Developmental Therapist | 1215 Coral Springs Dr, Cicero, IN 46034-9217 | 2007-04-02 |
| Find all providers in zip 46034 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174812853 | Ruchir Thakkar | Family Medicine | 5741 W Cermak Rd, Cicero, IL 60804-2129 | 2011-04-01 |
| 1427283290 | Sofia M Adawy | Family Medicine | 4747-51 West Cermak Road, Cicero, IL 60804-2508 | 2009-05-22 |
| 1124274311 | Alivio Medical Center, Inc. | Family Medicine | 4842 W Cermak Rd, Cicero, IL 60804-2531 | 2008-08-07 |
| 1093817082 | Harvey E Black | Family Medicine | 5813 East Seymour St, Cicero, NY 13039 | 2006-09-01 |
| 1639193998 | Ricardo C Dizon | Family Medicine | 1907 S Cicero Ave, Cicero, IL 60804-2546 | 2006-07-27 |
| 1457377830 | Eleni Kosmas | Family Medicine | 5586 Legionnaire Dr Ste 2, Cicero, NY 13039-3504 | 2006-07-15 |
| 1548299225 | Rosaura Licea | Family Medicine | 5712 W 35th St, Cicero, IL 60804-4222 | 2006-07-03 |
| 1750317061 | Amado Rueda | Family Medicine | 6001 W Cermak Rd, Cicero, IL 60804-2018 | 2006-06-26 |
| 1124066162 | Roselia Herrera | Family Medicine | 6039 W Cermak Rd, Cicero, IL 60804-2021 | 2006-06-03 |
| 1174502850 | Paolo S Pastore | Family Medicine | 8393 Elta Drive, Cicero, NY 13039 | 2006-01-11 |
| Find all providers in CICERO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.