Bryan V Lich, CCP

Primary specialty

General Acute Care HospitalTaxonomy code 282N00000X

License

169 Issued in GA

Practice address

17080 Safety St Ste 109
Fort Myers, FL 33908-7506

Phone

(888) 499-5672

Fax

(888) 501-0844

NPI assigned

Dec 19, 2013

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Perfusion.Com, Inc

  • Perfusionist
  • Fort Myers, FL
  • NPI 1144641093
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1387411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387411200000",
    "number": "1619398567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17080 SAFETY ST STE 109",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339087506",
            "telephone_number": "888-499-5672",
            "fax_number": "888-501-0844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17080 SAFETY ST STE 109",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339087506",
            "telephone_number": "888-499-5672",
            "fax_number": "888-501-0844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICH",
        "first_name": "BRYAN",
        "middle_name": "V",
        "name_prefix": "Mr.",
        "credential": "CCP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-12-19",
        "last_updated": "2013-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "GA",
            "license": "169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniil Libman, APN
• Lisa Libonati, FNP-BC, APRN, MSN
• Jason P Licausi, LMFT
• Raymond Paul Liccini, M.D.
• Elizabeth De la Caridad Licea Fornaris
• Kathy Lichter, P.T.A.
• Maribeth Lichty, ACSW,LCSW,CAP
• Amanda Lidgard, DO
• Claude P Lieber, MD
• Mark Ernest Liebetreu, OD

• General Acute Care Hospital in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• General Acute Care Hospital in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.