Provider Demographics
NPI:1144265026
Name:CENTRAL FLORIDA MEDICAL CARE,PA
Entity type:Organization
Organization Name:CENTRAL FLORIDA MEDICAL CARE,PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:LICHTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-360-0400
Mailing Address - Street 1:29320 US HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-8227
Mailing Address - Country:US
Mailing Address - Phone:352-360-0400
Mailing Address - Fax:352-360-0404
Practice Address - Street 1:29320 US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-8227
Practice Address - Country:US
Practice Address - Phone:352-360-0400
Practice Address - Fax:352-360-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0S0006324207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371631700Medicaid
FLCH3810OtherRAILROAD MEDICARE
FLCH3810OtherRAILROAD MEDICARE
FLE87741Medicare UPIN
FL371631700Medicaid