Ichtertz, Greg Lauritz

Ichtertz, Greg Lauritz is an individual health care provider with primary practice located at 415 S 28Th Ave , Hattiesburg MS 39401-7246. He recently has only one registered license in Allopathic & Osteopathic Physicians / Hospitalist, which is considered as his primary health care specialty. Ichtertz, Greg Lauritz can be contacted via phone (601) 288-4329.

Contact Information

Primary practice address
415 S 28Th Ave Hattiesburg MS 39401-7246
Phone: (601) 288-4329
Fax: (601) 288-3191
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Hospitalist 208M00000X 19698 Mississippi

Profile Details

NPI number 1598884454
LBN Legal business name Ichtertz, Greg Lauritz
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 29th, 2007
Last updated Jan 30th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598884454 NPPES
Mississippi MEDICAID 04936743
Mississippi Other 4045721
Mississippi Other P00420680

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