Individual
DR. GARY MELVIN LICKLIDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5002 PRAIRIE ROSE CT, MIDDLETON, WI 53562-2385
(608) 836-9623
Mailing address
5002 PRAIRIE ROSE CT, MIDDLETON, WI 53562-2385
(608) 836-9623
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
18083
WI
Other
Enumeration date
09/23/2009
Last updated
09/23/2009
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