Healthcare Provider Details

I. General information

NPI: 1083622955
Provider Name (Legal Business Name): ALMA R BICKNESE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W TAYLOR ST CHILDREN AND ADOLESCENT CENTER
CHICAGO IL
60612-4795
US

IV. Provider business mailing address

840 S WOOD ST DEPT. PEDIATRICS, UNIVERSITY OF ILLINOIS
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-7416
  • Fax: 312-996-5327
Mailing address:
  • Phone: 312-996-7865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberR8N53
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberR8N53
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: