Provider Demographics
NPI:1134354608
Name:FIEBIGER, ELSA VICTORIA (DO)
Entity type:Individual
Prefix:DR
First Name:ELSA
Middle Name:VICTORIA
Last Name:FIEBIGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ELSA
Other - Middle Name:VICTORIA
Other - Last Name:HENNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3955 PARKLAWN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5655
Mailing Address - Country:US
Mailing Address - Phone:952-831-4454
Mailing Address - Fax:
Practice Address - Street 1:3955 PARKLAWN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5655
Practice Address - Country:US
Practice Address - Phone:952-831-4454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-86372084P0800X
MN56157208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry