Provider Demographics
NPI:1245334622
Name:LICHTSHEIN, GIL (MD)
Entity type:Individual
Prefix:DR
First Name:GIL
Middle Name:
Last Name:LICHTSHEIN
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 1:7100 WEST CAMINO REAL
Mailing Address - Street 2:SUITE 404
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5510
Mailing Address - Country:US
Mailing Address - Phone:561-300-4052
Mailing Address - Fax:561-300-4051
Practice Address - Street 1:7100 WEST CAMINO REAL
Practice Address - Street 2:SUITE 404
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5510
Practice Address - Country:US
Practice Address - Phone:561-300-4052
Practice Address - Fax:561-300-4051
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2023-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME877122084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1342ZOtherPROVIDER