Provider Demographics
NPI:1164492823
Name:EISENFELD, LARRY STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:STEVEN
Last Name:EISENFELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12670 CREEKSIDE LANE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-8759
Mailing Address - Country:US
Mailing Address - Phone:239-482-2663
Mailing Address - Fax:239-482-3106
Practice Address - Street 1:12670 CREEKSIDE LANE
Practice Address - Street 2:STE 202
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-8759
Practice Address - Country:US
Practice Address - Phone:239-482-2663
Practice Address - Fax:239-482-3106
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0040040207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1164492823OtherCIGNA
FLD54476Medicare UPIN
FLK0865Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER