Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 5101018690 | MI |
N | 208600000X | Surgeon | 5101018690 | MI |
Y | 2086S0105X | Surgery of the Hand | 5101018690 | MI |
NPI | 1366761926 |
---|---|
Provider Name | Dr. Mayron Lichterman |
First Address | Kalamazoo, MI 49007-5341 |
Second Address | Kalamazoo, MI 49007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2010 |
Last Update Date | 05/10/2020 |