Basic Information
Provider Information | |||||||||
NPI: | 1538545785 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | FISHER-TITUS SPECIALISTS, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | EXECUTIVE UROLOGY SPECIALISTS | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 272 BENEDICT AVE | ||||||||
Address2: |   | ||||||||
City: | NORWALK | ||||||||
State: | OH | ||||||||
PostalCode: | 448572374 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4196688101 | ||||||||
FaxNumber: | 4196636036 | ||||||||
Practice Location | |||||||||
Address1: | 2800 HAYES AVE | ||||||||
Address2: | BUILDING D | ||||||||
City: | SANDUSKY | ||||||||
State: | OH | ||||||||
PostalCode: | 448707248 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4196278771 | ||||||||
FaxNumber: | 4196270363 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/10/2015 | ||||||||
LastUpdateDate: | 12/21/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | DELGADO | ||||||||
AuthorizedOfficialFirstName: | LAURIE | ||||||||
AuthorizedOfficialMiddleName: | S | ||||||||
AuthorizedOfficialTitleorPosition: | SENIOR VICE PRESIDENT, OPERATIONS | ||||||||
AuthorizedOfficialTelephone: | 4196606931 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | NORWALK AREA HEALTH SYSTEMS INC. | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |   |
No ID Information.