Healthcare Provider Details

I. General information

NPI: 1689685158
Provider Name (Legal Business Name): THOMAS F LIFFICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MULBERRY STREET
EVANSVILLE IN
47713-1298
US

IV. Provider business mailing address

415 MULBERRY ST
EVANSVILLE IN
47713-1230
US

V. Phone/Fax

Practice location:
  • Phone: 812-423-7791
  • Fax: 812-422-7558
Mailing address:
  • Phone: 812-423-7791
  • Fax: 812-422-7558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01027534
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: