Healthcare Provider Details

I. General information

NPI: 1508216805
Provider Name (Legal Business Name): ADAM NICHOLAS LICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4228 HOUMA BLVD STE 510
METAIRIE LA
70006-3015
US

IV. Provider business mailing address

4320 HOUMA BLVD FL 7
METAIRIE LA
70006-2961
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-6113
  • Fax: 504-988-7795
Mailing address:
  • Phone: 504-988-5344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number342090
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number342090
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number342090
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: