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NPI Code Detail

MEDICARE: SETH JUSTIN LICHTENSTEIN M.D

MEDICARE: SETH JUSTIN LICHTENSTEIN M.D
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
1207R00000XInternal Medicine Physician125069300IL
2207RC0000XCardiovascular Disease PhysicianA161705CA

General Provider Information

NPI Number : 1518310507
Entity Type Code : Individual
Provider Name (Legal Business Name) : SETH JUSTIN LICHTENSTEIN M.D
Provider Business Mailing Address
First Line : 1717 WEST CONGRESS PARKWAY, 1042 KELLOGG
Second Line :
City : CHICAGO
State : IL
Zip : 60612
Country : US
Telephone Number : 312-942-5000
Fax Number :
Provider Business Practice Location Address
First Line : 2001 SANTA MONICA BLVD STE 280W
Second Line :
City : SANTA MONICA
State : CA
Zip : 90404-2172
Country : US
Telephone Number : 310-829-7678
Fax Number : 310-829-6889
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2016
Last Update Date : 11/22/2022

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Directions to “ SETH JUSTIN LICHTENSTEIN M.D” Practice Location

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