Imaginemd

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

039.090525 Issued in IL

Legal business name

IMAGINEMD

Practice address

10 S Riverside PLZ Ste 2225
Chicago, IL 60606-3707

Phone

(312) 374-5860

NPI assigned

Aug 9, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Alex Lickerman, MD

Title

Ceo

Phone

(312) 374-5860

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1533772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533772800000",
    "number": "1437638574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 652",
            "city": "CLEMSON",
            "state": "SC",
            "postal_code": "296330652",
            "telephone_number": "773-364-0478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 S RIVERSIDE PLZ STE 2225",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606063707",
            "telephone_number": "312-374-5860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGINEMD",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-09",
        "last_updated": "2018-08-09",
        "status": "A",
        "authorized_official_last_name": "LICKERMAN",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "312-374-5860",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "039.090525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pil Bin Im, M.D.
• Imagination Grove Play Therapy PLLC
• Imaginative SLP, LLC.
• Imagine Healthcare LLC
• Imagine Therapy Mindfulness Healing PLLC
• Imaginenation ABA LLC
• Tanya Imam, LCSW
• Imani Healthcare LLC
• Manouchehr Imani, MD
• Iyare Kingsley Imanlihen, LCSW

• Internal Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.