Basic Information
| Provider Information | |||||||||
| NPI: | 1164454625 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FICHMAN | ||||||||
| FirstName: | HERBERT | ||||||||
| MiddleName: | MAURICE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7615 TARPON COVE CIR | ||||||||
| Address2: | |||||||||
| City: | LAKE WORTH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334676930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619679263 | ||||||||
| FaxNumber: | 5619679263 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 S CONGRESS AVE | ||||||||
| Address2: | |||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334454616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612743100 | ||||||||
| FaxNumber: | 5612743144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 12/14/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | OS8809 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2713331-00 | 05 | FL | MEDICAID | 16386 | 01 | FL | BLUE CROSS/BLUE SHIELD | OTHER |