Provider Demographics
NPI:1134138332
Name:LICHTMAN, MICHAEL (CNIM)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LICHTMAN
Suffix:
Gender:
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20100 N 78TH PL APT 2088
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-3838
Mailing Address - Country:US
Mailing Address - Phone:602-292-1455
Mailing Address - Fax:
Practice Address - Street 1:20100 N 78TH PL APT 2088
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-3838
Practice Address - Country:US
Practice Address - Phone:602-292-1455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5702111N00000X
AZ1721246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ100608Medicare ID - Type Unspecified