Provider Demographics
NPI:1205843919
Name:LICHTINGER, MOISES (MD)
Entity Type:Individual
Prefix:
First Name:MOISES
Middle Name:
Last Name:LICHTINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 N FEDERAL HIGHWAY
Mailing Address - Street 2:BLG B
Mailing Address - City:FT. LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308
Mailing Address - Country:US
Mailing Address - Phone:954-229-6000
Mailing Address - Fax:
Practice Address - Street 1:4701 N FEDERAL HIGHWAY
Practice Address - Street 2:BLG B
Practice Address - City:FT. LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-229-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39493207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066711100Medicaid
FLE15413Medicare UPIN
FL95965Medicare ID - Type Unspecified