Individual
CHARLES PETER LICHTY II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
833 SAINT VINCENTS DR STE 300, POB III, BIRMINGHAM, AL 35205-1612
(205) 939-4512
(205) 939-4519
Mailing address
833 SAINT VINCENTS DR STE 300, POB III, BIRMINGHAM, AL 35205-1612
(205) 939-4512
(205) 939-4519
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
00024704
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
132874
—
AL
01
—
1487627766
BCBS AL
AL
Enumeration date
02/08/2006
Last updated
03/22/2021
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