LICUDINE & LICUDINE MD SC (NPI# 1538245832) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538245832 |
| Entity Type | Organization |
| Organization Name | LICUDINE & LICUDINE MD SC |
| Practice Address |
4758 W Washington Blvd Chicago IL 60644-3619 |
| Mailing Address |
7049 N Kilpatrick Ave Lincolnwood IL 60712-2128 |
| Practice Telephone | 7733794348 |
| Mailing Telephone | 8476777264 |
| Enumeration Date | 2006-10-29 |
| Last Update Date | 2010-04-13 |
| Authorized Official Name | DR. NORMITA M LICUDINE (SECRETARY) |
| Authorized Official Telephone | 7733794348 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208600000X | Surgery | 036046217 | IL | Allopathic & Osteopathic Physicians |
| Y | 207Q00000X | Family Medicine | 036051696 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036046217 | 05 | |
| IL | 036051696 | 05 |
| Street Address |
4758 W WASHINGTON BLVD |
| City | CHICAGO |
| State | IL |
| Zip Code | 60644-3619 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437283496 | Wcc Pharmacy,inc. | Pharmacy | 4758 W Washington Blvd, Chicago, IL 60644-3619 | 2007-03-14 |
| 1922196971 | Floramado Aragon Licudine | Surgery | 4758 W Washington Blvd, Chicago, IL 60644-3619 | 2006-10-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710535638 | Marta Yvonne Palmer | Technician | 5008 W Adams, Chicago, IL 60644 | 2019-09-04 |
| 1861056848 | B U I L D Incorporated | Social Worker | 5100 W Harrison St., Chicago, IL 60644 | 2019-04-25 |
| 1851806269 | Habilitative Systems, Inc. | Case Management | 4732 W Ohio St, Chicago, IL 60644 | 2017-12-07 |
| 1336408665 | Meghan Nancy Daw | Dietitian, Registered | 646 S Central Ave, Chicago, IL 60644 | 2012-05-07 |
| 1164790515 | Elizabeth Eleanor Reid-tate | Pharmacist | 5222 W. Madison Avenue, Chicago, IL 60644 | 2011-12-13 |
| 1134458466 | Power Teen Program | Psychologist | 300 N Central Ave, Chicago, IL 60644 | 2009-12-16 |
| 1417198342 | Betty Jean Lofton | Counselor | 5938 W. Midway Park, Chicago, IL 60644 | 2009-03-24 |
| 1881856094 | Sanjay M. Patel M.d. S.c. | Psychiatry & Neurology | 5730 W. Roosevelt Road, Chicago, IL 60644 | 2008-06-29 |
| 1639348691 | Ysl Care, Inc | Community Based Residential Treatment Facility, Mental Illness | 5107-21 West Jackson Blvd, Chicago, IL 60644 | 2008-02-25 |
| 1073795845 | Maryanne Rakidzioski | Occupational Therapist | 5103 W Jackson Blvd, Chicago, IL 60644 | 2007-12-03 |
| Find all providers in zip 60644 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053911495 | Moataz Barkat | Family Medicine | 3315 W 66th Pl, Chicago, IL 60629-3427 | 2020-10-26 |
| 1558976589 | Jasmine Ashley Fowler | Family Medicine | 2416 N Lotus Ave, Chicago, IL 60639-1435 | 2020-09-15 |
| 1720699176 | Healing Hands Resource Center Streator | Family Medicine | 2128 S Central Park Ave, Chicago, IL 60623-3113 | 2020-08-10 |
| 1285251892 | Soe Lwin Oo | Family Medicine | 1625 E 75th St # 1, Chicago, IL 60649-3603 | 2020-06-30 |
| 1124645700 | Timothy Alan Williams Jr. | Family Medicine | 1625 E 75th St Fl 1, Chicago, IL 60649-3603 | 2020-06-30 |
| 1194340026 | Kaysha Lynne Ribao | Family Medicine | 2116 S Springfield Ave, Chicago, IL 60623-2465 | 2020-06-16 |
| 1932724341 | Toni Kurian | Family Medicine | 1550 S Indiana Ave Apt 407, Chicago, IL 60605-4822 | 2020-06-11 |
| 1528689486 | Thurman J Robertson | Family Medicine | 1950 W. Polk Street, 7th Floor, Chicago, IL 60612-3714 | 2020-05-01 |
| 1629697297 | Lyndsey Danielle Johnson | Family Medicine | 2804 W Walton St, Chicago, IL 60622-4450 | 2020-04-13 |
| 1730708884 | Iruoma Genevieve Nwangwu | Family Medicine | 1950 W Polk Street, Chicago, IL 60612-3714 | 2020-04-09 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.