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Individual
LEE LICHTENBERG
Active
Individual
LEE LICHTENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
36054148
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036054148
MEDICAID
IL
01
—
206147
MEDICARE PTAN (GROUP)
IL
01
—
206147236
MEDICARE PTAN (INDIVIDUAL)
IL
05
—
36054148
—
IL
Enumeration date
12/30/2005
Last updated
12/16/2013
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