Provider Demographics
NPI:1154347961
Name:LICHSTRAHL, ALAN L (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:L
Last Name:LICHSTRAHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2100 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-3765
Mailing Address - Country:US
Mailing Address - Phone:954-456-8900
Mailing Address - Fax:954-457-9118
Practice Address - Street 1:2100 E HALLANDALE BEACH BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-3765
Practice Address - Country:US
Practice Address - Phone:954-456-8900
Practice Address - Fax:954-457-9118
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0020178207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA93109Medicare ID - Type Unspecified
FLD27711Medicare UPIN