Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 237195 | MA |
Y | 207N00000X | Dermatologist | DR.0058361 | CO |
NPI | 1043411473 |
---|---|
Provider Name | Dr. Michael Keith Lichtman |
First Address | Denver, CO 80247-1314 |
Second Address | Lafayette, CO 80026-3370 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 02/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
027998 | KAISER COMMERCIAL NUMBER (01) | CO |
110083961A | (05) | MA |
BP1-0026117 | INSTITUTIONAL PERMIT (01) |