Provider Demographics
NPI:1124115027
Name:LICHTINGER, DAVID RICHARD (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RICHARD
Last Name:LICHTINGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29320 US HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-8227
Mailing Address - Country:US
Mailing Address - Phone:352-360-0400
Mailing Address - Fax:352-360-0404
Practice Address - Street 1:29320 US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-8227
Practice Address - Country:US
Practice Address - Phone:352-360-0400
Practice Address - Fax:352-360-0404
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS006324207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110060650OtherMEDICARE RAILROAD
FL371631700Medicaid
FL80689OtherBLUE CROSS OF FLORIDA
FL80689OtherBLUE CROSS OF FLORIDA
FL371631700Medicaid