Organization
IMAGINEMD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALEX LICKERMAN MD (CEO)
(312) 374-5860
Entity
Organization
Contact information
Practice address
10 S RIVERSIDE PLZ STE 2225, CHICAGO, IL 60606-3707
(312) 374-5860
Mailing address
PO BOX 652, CLEMSON, SC 29633-0652
(773) 364-0478
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
039.090525
IL
Other
Enumeration date
08/09/2018
Last updated
08/09/2018
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