Healthcare Provider Details

I. General information

NPI: 1861481491
Provider Name (Legal Business Name): TIMOTHY J LICHTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1838 FLORENCE PIKE STE B
BURLINGTON KY
41005-1838
US

IV. Provider business mailing address

237 WILLIAM HOWARD TAFT RD
CINCINNATI OH
45219-2610
US

V. Phone/Fax

Practice location:
  • Phone: 859-334-0217
  • Fax: 859-534-5888
Mailing address:
  • Phone: 513-263-8527
  • Fax: 513-263-8622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-057782
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: