Provider Demographics
NPI:1154356335
Name:LICHTENBERGER, ANDRES JOHN JACOB (MD)
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:JOHN JACOB
Last Name:LICHTENBERGER
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:PO BOX 402808
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-0808
Mailing Address - Country:US
Mailing Address - Phone:305-695-0644
Mailing Address - Fax:305-532-1612
Practice Address - Street 1:400 W 41ST ST
Practice Address - Street 2:#103
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3516
Practice Address - Country:US
Practice Address - Phone:305-695-0644
Practice Address - Fax:305-532-1612
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95046207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI70738Medicare UPIN
FLAB820ZMedicare PIN