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1699766154

NPI Code Detail

MEDICARE: DR. PAUL R LICHTENSTEIN MD

MEDICARE: DR. PAUL R LICHTENSTEIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	8814	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1Z3294	OTHER	AZ	HEALTHNET
2	AZ0056210	OTHER	AZ	BCBS
3	230996	OTHER		STATE
4	21108814	OTHER	AZ	STATE FUND

General Provider Information

NPI Number	:	1699766154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL R LICHTENSTEIN MD

Provider Business Mailing Address
First Line	:	5200 E FARNESS DR
Second Line	:	STE 100
City	:	TUCSON
State	:	AZ
Zip	:	85712-2140
Country	:	US
Telephone Number	:	520-326-6882
Fax Number	:	520-326-6886

Provider Business Practice Location Address
First Line	:	5200 E FARNESS DR
Second Line	:	STE 100
City	:	TUCSON
State	:	AZ
Zip	:	85712-2140
Country	:	US
Telephone Number	:	520-326-6882
Fax Number	:	520-326-6886

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	01/11/2008

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Directions to “ DR. PAUL R LICHTENSTEIN MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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