Provider Demographics
NPI:1326042656
Name:WAIZENEGGER, LISA J (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:WAIZENEGGER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:15280 NW 79TH CT STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5873
Mailing Address - Country:US
Mailing Address - Phone:305-558-3724
Mailing Address - Fax:786-907-4485
Practice Address - Street 1:5830 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-4311
Practice Address - Country:US
Practice Address - Phone:407-658-0228
Practice Address - Fax:407-282-5483
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2022-12-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME98558207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH238ZMedicare PIN
H90616Medicare UPIN