LICUDINE & LICUDINE MD SC NPI 1538245832

NPI Information

  • NPI: 1538245832
  • Provider Name: LICUDINE & LICUDINE MD SC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Address: 4758 W WASHINGTON BLVD
    CHICAGO, IL
    ZIP 60644
  • Phone: (773) 379-4348

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NPI Details

LICUDINE & LICUDINE MD SC is a family medicine in Chicago, IL. The provider is 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. LICUDINE & LICUDINE MD SC NPI is 1538245832. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

4758 W WASHINGTON BLVD
CHICAGO, IL
ZIP 60644-619
Phone: (773) 379-4348

The provider's authorized official is Normita M Licudine .
The authorized official title is Secretary and has the following contact phone number (773) 379-4348.

The enumeration date for this NPI number is 10/29/2006 and was last updated on 4/13/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208600000XSurgery036046217ILLINOISNo
2207Q00000XFamily Medicine036051696ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1D12996MEDICARE UPINILLINOIS
2036046217MEDICAIDILLINOIS
3472970MEDICARE ID-TYPE UNSPECIFIEDILLINOIS
4487530MEDICARE ID-TYPE UNSPECIFIEDILLINOIS
5036051696MEDICAIDILLINOIS
6C41866MEDICARE UPINILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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