Provider Demographics
NPI:1750595062
Name:PAUL R. LICHTENSTEIN, M.D., P.C.
Entity type:Organization
Organization Name:PAUL R. LICHTENSTEIN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LICHTENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-326-6882
Mailing Address - Street 1:5200 E FARNESS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2140
Mailing Address - Country:US
Mailing Address - Phone:520-326-6882
Mailing Address - Fax:520-326-6886
Practice Address - Street 1:5200 E FARNESS DR STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2140
Practice Address - Country:US
Practice Address - Phone:520-326-6882
Practice Address - Fax:520-326-6886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ8814174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ21108814OtherSTATE FUND-ICA
AZ2309960OtherDES
AZAZ0056210OtherBCBS
AZ1Z3294OtherHEALTHNET
AZ2309960OtherDES
AZC99870Medicare UPIN
AZAZ0056210OtherBCBS