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NPI Code Detail

MEDICARE: DAVID DOUGLAS LICK

MEDICARE: DAVID DOUGLAS LICK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician4301076522FM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1080F370780OTHERMIBCBSM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962478974
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID DOUGLAS LICK
Provider Business Mailing Address
First Line : 44250 DEQUINDRE RD
Second Line :
City : STERLING HEIGHTS
State : MI
Zip : 48314-1002
Country : US
Telephone Number : 248-964-0400
Fax Number : 248-964-0401
Provider Business Practice Location Address
First Line : 44250 DEQUINDRE RD
Second Line :
City : STERLING HEIGHTS
State : MI
Zip : 48314-1002
Country : US
Telephone Number : 248-964-0400
Fax Number : 248-964-0401
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2006
Last Update Date : 10/23/2020

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Directions to “ DAVID DOUGLAS LICK ” Practice Location

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