Provider Demographics
NPI:1942438767
Name:KENIGSBERG FECHTER, LISA ERIN (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ERIN
Last Name:KENIGSBERG FECHTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ERIN
Other - Last Name:KENIGSBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:1131 N 35TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5403
Practice Address - Country:US
Practice Address - Phone:954-265-2234
Practice Address - Fax:954-893-6300
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0432652080P0205X
FLME1348662080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023663100Medicaid