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General NPI Number Information
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NPI Number | 1538245832
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Entity Type | Organization
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Legal Business Name | LICUDINE & LICUDINE MD SC
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Dates
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Enumeration Date | 10/29/2006
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Last Update Date | 04/13/2010
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Provider Practice Location Address
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Address Line | 4758 W WASHINGTON BLVD
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City | CHICAGO
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State | IL
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Zip | 60644-3619
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Country | US
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Telephone | 773-379-4348
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Fax |
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Provider Business Mailing Address
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Address Line | 7049 N KILPATRICK AVE
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-2128
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Country | US
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Telephone | 847-677-7264
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. NORMITA M LICUDINE
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Credential | MD
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Telephone | 773-379-4348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036046217
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036051696
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License Number State | IL
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