Provider Demographics
NPI:1881663458
Name:ADVANCED ANESTHESIA SPECIALIST PLLC
Entity Type:Organization
Organization Name:ADVANCED ANESTHESIA SPECIALIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LICHTENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-529-2551
Mailing Address - Street 1:PO BOX 3978
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33775-3978
Mailing Address - Country:US
Mailing Address - Phone:770-237-1561
Mailing Address - Fax:770-237-1124
Practice Address - Street 1:7300 BRYAN DAIRY RD
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1534
Practice Address - Country:US
Practice Address - Phone:727-529-2551
Practice Address - Fax:770-237-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID NUMBER