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NPI Code Detail

MEDICARE: DR. KATHERINE R LICHTENBERG D.O.

MEDICARE: DR. KATHERINE R LICHTENBERG D.O.
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
12083P0901XPublic Health & General Preventive Medicine Physician113041MO
2207Q00000XFamily Medicine Physician113041MO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00215429OTHERMORAILROAD MEDICARE

General Provider Information

NPI Number : 1487627568
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KATHERINE R LICHTENBERG D.O.
Provider Business Mailing Address
First Line : 601 NIRK AVE
Second Line :
City : KIRKWOOD
State : MO
Zip : 63122-5626
Country : US
Telephone Number : 314-606-5644
Fax Number :
Provider Business Practice Location Address
First Line : 6707 W HAMPTON AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53218-4833
Country : US
Telephone Number : 414-508-0839
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2006
Last Update Date : 02/13/2026

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