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General NPI Number Information
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NPI Number | 1336349240
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Entity Type | Organization
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Legal Business Name | CRAIG H LICHTBLAU MD PA
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 12/12/2007
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Provider Practice Location Address
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Address Line | 550 NORTHLAKE BLVD
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City | NORTH PALM BEACH
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State | FL
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Zip | 33408-5409
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Country | US
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Telephone | 561-842-3694
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Fax | 561-842-3774
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Provider Business Mailing Address
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Address Line | 550 NORTHLAKE BLVD
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City | NORTH PALM BEACH
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State | FL
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Zip | 33408-5409
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Country | US
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Telephone | 561-842-3694
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Fax | 561-842-3774
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Authorized Official
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Title or Position | MD/OWNER
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Name | CRAIG H LICHTBLAU
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Credential | MD
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Telephone | 561-842-3694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME0056279
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License Number State | FL
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