Provider Demographics
NPI:1225395668
Name:KENNETH C. FISCHER, M.D., P.A.
Entity Type:Organization
Organization Name:KENNETH C. FISCHER, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:CLYDE
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-696-7666
Mailing Address - Street 1:1190 NW 95TH ST
Mailing Address - Street 2:SUITE #402
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33150-2063
Mailing Address - Country:US
Mailing Address - Phone:305-696-7666
Mailing Address - Fax:305-694-0111
Practice Address - Street 1:1190 NW 95TH ST
Practice Address - Street 2:SUITE #402
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2063
Practice Address - Country:US
Practice Address - Phone:305-696-7666
Practice Address - Fax:305-694-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME246752084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035837100Medicaid
169560400OtherDEPARTMENT OF LABOR
FL060019520OtherRAILROAD MEDICARE
FL92148Medicare PIN
FLD82598Medicare UPIN