| Licudine & Licudine MD SC | |
|
4758 W Washington Blvd Chicago IL 60644-3619 | |
| (773) 379-4348 | |
| Not Available |
| Full Name | Licudine & Licudine MD SC |
|---|---|
| Speciality | Family Medicine |
| Location | 4758 W Washington Blvd, Chicago, Illinois |
| Authorized Official Name and Position | Normita M Licudine (SECRETARY) |
| Authorized Official Contact | 7733794348 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Licudine & Licudine MD SC 7049 N Kilpatrick Ave Lincolnwood IL 60712-2128 Ph: (847) 677-7264 | Licudine & Licudine MD SC 4758 W Washington Blvd Chicago IL 60644-3619 Ph: (773) 379-4348 |
| NPI Number | 1538245832 |
|---|---|
| Provider Enumeration Date | 10/29/2006 |
| Last Update Date | 04/13/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538245832 | NPI | - | NPPES |
| 036046217 | Medicaid | IL | |
| 036051696 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036051696 (Illinois) | Primary |
| 208600000X | Surgery | 036046217 (Illinois) | Secondary |
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