Individual
DAVID OMAR HENRIQUEZ TICAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
710 N FAIRBANKS CT STE 2-458, CHICAGO, IL 60611-3013
(312) 926-3211
(312) 503-8259
Mailing address
1 BAYLOR PLZ, MC 315, HOUSTON, TX 77030-3411
(713) 798-5490
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
036164840
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/21/2017
Last updated
09/06/2023
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