Provider Demographics
NPI:1487618153
Name:LIFTIG, STEPHEN R (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:LIFTIG
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 1:2516 7TH ST W
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-1452
Mailing Address - Country:US
Mailing Address - Phone:239-994-6771
Mailing Address - Fax:239-303-9897
Practice Address - Street 1:2516 7TH ST W
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1452
Practice Address - Country:US
Practice Address - Phone:239-994-6771
Practice Address - Fax:239-303-9897
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL37672208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039866700Medicaid
FL039866700Medicaid