Individual
MATTHEW LICKERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4201 W MEDICAL CENTER DR, MCHENRY, IL 60050
(815) 759-3100
(815) 363-9044
Mailing address
2790 SANDALWOOD RD, BUFFALO GROVE, IL 60089-6645
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036107649
IL
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
ME107463
FL
Other
Enumeration date
08/15/2006
Last updated
08/10/2018
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