Healthcare Provider Details

I. General information

NPI: 1124476296
Provider Name (Legal Business Name): KATHERINE MACAULEY LIGTENBERG GIVEN MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE GIVEN LIGTENBERG MD, PHD

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6574 OAKMONT DR STE B
SANTA ROSA CA
95409-5958
US

IV. Provider business mailing address

4700 EXCHANGE CT STE 110
BOCA RATON FL
33431-4450
US

V. Phone/Fax

Practice location:
  • Phone: 707-579-4239
  • Fax: 707-579-0459
Mailing address:
  • Phone: 561-948-0291
  • Fax: 561-859-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125068796
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA167878
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA167878
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: