Provider Demographics
NPI:1407024169
Name:FISZER, LUCIANO (MD)
Entity type:Individual
Prefix:
First Name:LUCIANO
Middle Name:
Last Name:FISZER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5480 SW 178TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33331-2356
Mailing Address - Country:US
Mailing Address - Phone:917-981-5741
Mailing Address - Fax:
Practice Address - Street 1:730 NW 107TH AVE STE 210
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-3104
Practice Address - Country:US
Practice Address - Phone:786-310-2283
Practice Address - Fax:786-384-7277
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME128559208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018413000Medicaid
SCAA52927951Medicare PIN