Provider Demographics
NPI:1386751352
Name:LICHTENSTEIN, MICHAEL JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:LICHTENSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DRIVE, RM 5.069R
Mailing Address - Street 2:UTHSCSA, UTHSCSA, DEPT OF MEDICINE
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3900
Mailing Address - Country:US
Mailing Address - Phone:210-617-5311
Mailing Address - Fax:210-949-3060
Practice Address - Street 1:8300 FLOYD CURL DRIVE
Practice Address - Street 2:UT MEDICINE AT SAN ANTONIO-GERIATRICS
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4403
Practice Address - Country:US
Practice Address - Phone:210-450-9100
Practice Address - Fax:210-450-6009
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1748207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX045945501Medicaid
TXJ0071932OtherTEXAS DEPARTMENT OF PUBLI
AL9392008OtherDEA
TX87G484Medicare PIN
TXJ0071932OtherTEXAS DEPARTMENT OF PUBLI