Provider Demographics
NPI:1043416316
Name:LIECHTY, JOSEPH MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MATTHEW
Last Name:LIECHTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:621 N HALL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75226-1305
Mailing Address - Country:US
Mailing Address - Phone:214-821-9600
Mailing Address - Fax:214-823-5290
Practice Address - Street 1:4716 ALLIANCE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5306
Practice Address - Country:US
Practice Address - Phone:972-665-9100
Practice Address - Fax:972-665-4711
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP30292086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100304440Medicaid
KY7100304440Medicaid