Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 036-065063 | IL |
N | 207T00000X | Neurosurgeon | 103790 | MT |
Y | 207T00000X | Neurosurgeon | 8147 | SD |
NPI | 1114976289 |
---|---|
Provider Name | Terence R. Lichtor |
First Address | Wausau, WI 54401-3771 |
Second Address | Wausau, WI 54401-3771 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 06/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D16519 | (02) | |
D16519 | (02) | IL |