# IMAGINEMD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437638574
- **Authorized official:** DR. ALEX LICKERMAN MD (CEO)
- **Authorized official phone:** (312) 374-5860

## Contact information

- **Practice address:** 10 S RIVERSIDE PLZ STE 2225, CHICAGO, IL 60606-3707
- **Practice address phone:** (312) 374-5860
- **Mailing address:** PO BOX 652, CLEMSON, SC 29633-0652
- **Mailing address phone:** (773) 364-0478

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 039.090525 | IL | Yes |

## Other

- **Enumeration date:** 08/09/2018
- **Last updated:** 08/09/2018