Provider Demographics
NPI:1447357900
Name:LICHTENTHAL, PETER R (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:R
Last Name:LICHTENTHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 E ELVIRA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706-7124
Mailing Address - Country:US
Mailing Address - Phone:520-874-7400
Mailing Address - Fax:520-874-3425
Practice Address - Street 1:1501 N CAMPBELL AVNEUE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-0001
Practice Address - Country:US
Practice Address - Phone:520-694-8888
Practice Address - Fax:520-626-6066
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23120207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ467739Medicaid
C42511Medicare UPIN
27339Medicare ID - Type Unspecified
AZ467739Medicaid