Organization
PROFESSIONAL PEDIATRICS, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN M. LICHTENBERGER MD (PRESIDENT)
(606) 833-8480
Entity
Organization
Contact information
Practice address
105 THOMPSON RD, RUSSELL, KY 41169-1645
(606) 833-8480
Mailing address
105 THOMPSON RD, RUSSELL, KY 41169-1645
(606) 833-8480
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0918645
—
OH
05
—
64296262
—
KY
Enumeration date
06/18/2007
Last updated
08/06/2012
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