Provider Demographics
NPI:1154683043
Name:LICHTMANN, DANIEL MICAH (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MICAH
Last Name:LICHTMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15004 INNOVATION DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128
Mailing Address - Country:US
Mailing Address - Phone:858-605-7969
Mailing Address - Fax:858-605-7172
Practice Address - Street 1:15004 INNOVATION DRIVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128
Practice Address - Country:US
Practice Address - Phone:858-605-7969
Practice Address - Fax:858-605-7172
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA128188208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics