Active NPI
Norman J Licht, M.D.
- Orthopaedic Foot and Ankle Surgery Physician
- Traverse City, MI
National Provider Identifier
1942224894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Foot and Ankle Surgery Physician
- License
- 4301047445
- Practice address
- 4045 W Royal Dr
Traverse City, MI 49684-8965 - Phone
- (231) 935-0900
- Fax
- (231) 935-0308
- NPI assigned
- Jul 26, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Foot and Ankle Surgery Physician | 207XX0004X | 4301047445 | MI | Primary |
Addresses
Primary practice location
4045 W Royal Dr
Traverse City, MI 49684-8965
Mailing address
4045 W Royal Dr
Traverse City, MI 49684-8965
Phone (231) 935-0900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 103105006 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Munson Healthcare Grayling | Past | Accepting new patients | |
| Munson Healthcare Grayling | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Prudenville Community Health Center
- Rural Health Clinic/Center
- Prudenville, MI
- NPI 1144626052
-
dba Roscommon Community Health Center
- Family Medicine Physician
- Roscommon, MI
- NPI 1598131617
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1942224894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4045 W ROYAL DR",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496848965",
"telephone_number": "231-935-0900",
"fax_number": "231-935-0308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4045 W ROYAL DR",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496848965",
"telephone_number": "231-935-0900",
"fax_number": "231-935-0308"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICHT",
"first_name": "NORMAN",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207XX0004X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery, Foot and Ankle Surgery",
"state": "MI",
"license": "4301047445",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "103105006",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Traverse City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.