Individual
ALAN J LICUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12500 AURORA DR, PLEASANT PRAIRIE, WI 53158
(262) 854-5000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036128087
IL
208600000X
Surgery Physician
Primary
66270-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100061195
—
WI
Enumeration date
05/03/2007
Last updated
10/07/2025
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