Individual
DR. MARK R LICHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
258 S CHICKASAW TRL STE 202, ORLANDO, FL 32825-3501
(407) 303-6865
(407) 303-6537
Mailing address
805 CENTURY MEDICAL DR STE C, TITUSVILLE, FL 32796-2100
(321) 268-6868
(321) 267-2713
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
ME68004
FL
208800000X
Urology Physician
Primary
ME68004
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101986000
—
FL
Enumeration date
06/16/2005
Last updated
04/29/2025
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