Provider Demographics
NPI:1538285192
Name:LICHI, EDUARDO (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:LICHI
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 1:4375 RADIO RD #101
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-4372
Mailing Address - Country:US
Mailing Address - Phone:239-262-2058
Mailing Address - Fax:239-263-0643
Practice Address - Street 1:4375 RADIO RD #101
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-4372
Practice Address - Country:US
Practice Address - Phone:239-262-2058
Practice Address - Fax:239-263-0643
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME517112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07697BMedicare UPIN