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Organization
LICUDINE & LICUDINE MD SC
Active
Organization
LICUDINE & LICUDINE MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NORMITA M LICUDINE MD (SECRETARY)
(773) 379-4348
Entity
Organization
Contact information
Practice address
4758 W WASHINGTON BLVD, CHICAGO, IL 60644-3619
(773) 379-4348
Mailing address
7049 N KILPATRICK AVE, LINCOLNWOOD, IL 60712-2128
(847) 677-7264
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036051696
IL
208600000X
Surgery Physician
036046217
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036046217
—
IL
05
—
036051696
—
IL
Enumeration date
10/29/2006
Last updated
04/13/2010
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