Individual
DR. MARK ALAN LICHTENFELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
14748 MANCHESTER RD # B, BALLWIN, MO 63011-3706
(636) 256-3636
(636) 256-8734
Mailing address
358 LITTANY LN, CHESTERFIELD, MO 63017-2308
(314) 434-8666
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
36554
MO
207Q00000X
Family Medicine Physician
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100939
HEALTHLINK PROVIDER NUMBE
MO
01
—
5966114
AETNA PROVIDER #
MO
Enumeration date
09/28/2006
Last updated
07/08/2007
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