| Doctor Name: | DR. MARK R LICHT |
| NPI Number: | 1306841473 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | ME68004 |
| Business Practice Address: | 7280 W Palmetto Park Rd Ste 305 Boca Raton, FL - 334333422 |
| Business Phone Number: | 5619556025 |
| Business Fax Number: | 5619556069 |
| Mailing Address: | 5350 W. Atlantic Avenue, Suite 102 DELRAY BEACH |
| State: | FL |
| Postal Code: | 334848122 |
| Phone Number: | 5614964444 |
| Fax Number: | 5614962001 |
| NPI Enumeration Date: | 06/16/2005 |
| NPI Last Update Date: | 08/04/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | ME68004 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |