Provider Demographics
NPI:1275582132
Name:LICHTENWALTER, CHRISTOPHER S (MD)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:S
Last Name:LICHTENWALTER
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 1:10238 E HAMPTON AVE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-3316
Mailing Address - Country:US
Mailing Address - Phone:480-889-1573
Mailing Address - Fax:
Practice Address - Street 1:10238 E HAMPTON AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3316
Practice Address - Country:US
Practice Address - Phone:480-889-1573
Practice Address - Fax:480-889-1574
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43102207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ526239Medicaid
AZZ138438Medicare PIN
AZ526239Medicaid