Provider Demographics
NPI:1609921659
Name:PHILIP M. LICHTENFELD MD, PROFESSIONAL CORP.
Entity Type:Organization
Organization Name:PHILIP M. LICHTENFELD MD, PROFESSIONAL CORP.
Other - Org Name:ENCINO PHYSICIANS MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:LICHTENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-784-7784
Mailing Address - Street 1:16550 VENTURA BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16550 VENTURA BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2004
Practice Address - Country:US
Practice Address - Phone:818-784-7784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty