Provider Demographics
NPI:1942367693
Name:LICHTENSTEIN, JUDITH SARA (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:SARA
Last Name:LICHTENSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:737 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 2240
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2615
Mailing Address - Country:US
Mailing Address - Phone:312-944-1701
Mailing Address - Fax:312-944-0418
Practice Address - Street 1:737 N MICHIGAN AVE
Practice Address - Street 2:SUITE 2240
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2615
Practice Address - Country:US
Practice Address - Phone:312-944-1701
Practice Address - Fax:312-944-0418
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL360550482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL640470Medicare ID - Type Unspecified