Individual
JAMES M. WICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2151 WAUKEGAN RD, SUITE 100, BANNOCKBURN, IL 60015-1885
(847) 444-5300
(847) 267-0694
Mailing address
2151 WAUKEGAN RD, SUITE 100, BANNOCKBURN, IL 60015-1885
(847) 444-5300
(847) 267-0694
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
36047747
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04915267
BLUE CROSS BLUE SHIELD
IL
01
—
110047115
RAILROAD MEDICARE
IL
05
—
36047747
—
IL
Enumeration date
07/20/2006
Last updated
10/13/2020
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