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Licensee Details <br />North Carolina Medical Board <br />Information as of May 8, 2009 <br />Michael John Fisher, MD <br />Public File: NO <br />Current License Status: Active <br />License Number: 9501239 <br />Issue Date: 09/16/1995 <br />Limitations: <br />Address <br />123 High Hickory Rd <br />Chapel Hili, NC 27516-5545 <br />i ~~:~~~15c.?~.' ' ... ... <br />Practice Phone; <br />Individual information <br />Year of Birth: 1947 Annual Renewal Date: 10/15/20`09 <br />PrimaNj+!'~Specialty°~Family Practice Board Certified: Yes ABMS or AOA Approved: Yes <br />Secofidary $pecialty~~` <br />Ared.~;$.~•.:of~P:racfic,e'.%.:_~' <br />., <br />Hospital Privileges: University of North Carolina Hospitals <br />Out Of State Licenses: Illinois,New York <br />Out Of Country Licenses: <br />T;Fte abQWe=StatQ:and Country Licenses may be currently Active or Inactive <br />Sbhool.Name <br />Univ of Cincinnati <br />Montefiore Hospital <br />., <br />Hide Licensure History <br />R~a~Qh GPdQ., 1 License <br />-. 'Number <br />°~ ~ 9501239 <br />Supervises Type <br />~INh.itten; Robin • PA <br />Xla, Hongling NP <br />Tvpe Grad Year <br />Medical School 1973 <br />PGY2 1976 <br />Active License <br />Subcategory Issue Date Expire Date <br />09/16/1.995 <br />Supervisor <br />Status Approval Date Inactive Date <br />Inactive <br />Active 10/17/2007 <br />Page 1 of 2 <br />ht>;p:~/www.ncmedboard.org/Clients/NCBOM/Public/Licensee Details.aspx?&EntityID=65214&PublicFile... 5/8/2C <br />