Licup, Alan J

Licup, Alan J is an individual health care provider with primary practice located at 12500 Aurora Dr , Pleasant Prairie WI 53158. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Licup, Alan J can be contacted via phone (262) 854-5000.

Contact Information

Primary practice address
12500 Aurora Dr Pleasant Prairie WI 53158
Phone: (262) 854-5000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 036128087 Illinois
Allopathic & Osteopathic Physicians / Surgery 208600000X 66270-20 Wisconsin

Profile Details

NPI number 1205048246
LBN Legal business name Licup, Alan J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 3rd, 2007
Last updated Nov 18th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205048246 NPPES
Wisconsin MEDICAID 100061195

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