Basic Information
| Provider Information | |||||||||
| NPI: | 1861481491 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LICHTER | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 237 WILLIAM HOWARD TAFT RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132638527 | ||||||||
| FaxNumber: | 5132638622 | ||||||||
| Practice Location | |||||||||
| Address1: | 1838 FLORENCE PIKE STE B | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410051838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593340217 | ||||||||
| FaxNumber: | 8595345888 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2005 | ||||||||
| LastUpdateDate: | 07/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35-057782 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 64117955 | 05 | KY | MEDICAID | 0743833 | 05 | OH | MEDICAID |