Healthcare Provider Details

I. General information

NPI: 1902888647
Provider Name (Legal Business Name): PAVEL LICHTENSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3719 DAUPHIN ST
MOBILE AL
36608-1753
US

IV. Provider business mailing address

PO BOX 7525
MOBILE AL
36670-0525
US

V. Phone/Fax

Practice location:
  • Phone: 251-471-3921
  • Fax: 251-476-5460
Mailing address:
  • Phone: 251-471-3921
  • Fax: 251-476-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number7738
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: