Provider Demographics
NPI:1659391738
Name:LICHTENSTEIN, ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:LICHTENSTEIN
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 1:9411 SILVERTHORN RD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777-3166
Mailing Address - Country:US
Mailing Address - Phone:727-424-2660
Mailing Address - Fax:
Practice Address - Street 1:701 6TH ST S
Practice Address - Street 2:BAYFRONT HEALTH DEPT OF ANESTHESIA
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4814
Practice Address - Country:US
Practice Address - Phone:727-424-2660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0072247207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32954OtherBCBS OF FL
P00680591OtherRAILROAD MCR ATTACHED TO GRP CF4811
FLME0072247OtherFL MEDICAL LICENSE NUMBER
FL261615700Medicaid
FL32954WMedicare PIN
FL261615700Medicaid