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Individual

DR. JAY CHARLES LICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
2402 WINNEBAGO ST, MADISON, WI 53704-5341
(608) 242-6840
(608) 245-6117
Mailing address
7974 UW HEALTH CT, MIDDLETON, WI 53562-5531

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
53723
WI
207V00000X
Obstetrics & Gynecology Physician
005103
AZ
207V00000X
Obstetrics & Gynecology Physician
2005041214
MO
207V00000X
Obstetrics & Gynecology Physician
Primary
53723
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200987303
MO
05
377023
AZ
Enumeration date
09/01/2006
Last updated
02/04/2021
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