Provider Demographics
NPI:1316283351
Name:ALLEN M. LIFTON, MD, PA
Entity type:Organization
Organization Name:ALLEN M. LIFTON, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LIFTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-485-2220
Mailing Address - Street 1:200 CAPRI ISLES BLVD
Mailing Address - Street 2:SUITE 7D
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-2302
Mailing Address - Country:US
Mailing Address - Phone:941-485-2220
Mailing Address - Fax:941-485-2150
Practice Address - Street 1:200 CAPRI ISLES BLVD
Practice Address - Street 2:SUITE 7D
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-2302
Practice Address - Country:US
Practice Address - Phone:941-485-2220
Practice Address - Fax:941-485-2150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME733052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG32928Medicare UPIN