MEDICARE: PHILIP LICHTENSTEIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	21814	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	K21814	OTHER	CHOICE CARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000032832	OTHER	ANTHEM

General Provider Information

NPI Number	:	1194724666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP LICHTENSTEIN MD

Provider Business Mailing Address
First Line	:	1100 PIKE ST
Second Line	:
City	:	COVINGTON
State	:	KY
Zip	:	41011-2135
Country	:	US
Telephone Number	:	859-655-6100
Fax Number	:	859-655-6179

Provider Business Practice Location Address
First Line	:	1100 PIKE ST
Second Line	:
City	:	COVINGTON
State	:	KY
Zip	:	41011-2135
Country	:	US
Telephone Number	:	859-655-6100
Fax Number	:	859-655-6179

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	07/08/2007

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Directions to “ PHILIP LICHTENSTEIN MD” Practice Location

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