Individual
LEE LICHTENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
302 RANDALL RD, GENEVA, IL 60134-4209
(630) 232-2391
(630) 232-2472
Mailing address
302 RANDALL RD, GENEVA, IL 60134-4209
(630) 232-2391
(630) 232-2472
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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