Healthcare Provider Details

I. General information

NPI: 1275642183
Provider Name (Legal Business Name): DAVID ALAN LICKSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5540 PGA BLVD SUITE 200
PALM BEACH GARDENS FL
33418-3987
US

IV. Provider business mailing address

5540 PGA BLVD STE 200
PALM BEACH GARDENS FL
33418-3987
US

V. Phone/Fax

Practice location:
  • Phone: 561-571-4000
  • Fax: 561-508-8890
Mailing address:
  • Phone: 561-571-4000
  • Fax: 561-491-2271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME84765
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: