Active NPI
Normita Madamba Licudine, MD
- Family Medicine Physician
- Chicago, IL
National Provider Identifier
1831287887
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036051696
- Practice address
- 4758 West Washington Blvd
Chicago, IL 60644 - Phone
- (773) 379-4348
- Fax
- (773) 379-4034
- NPI assigned
- Oct 11, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036051696 | IL | Primary |
Addresses
Primary practice location
4758 West Washington Blvd
Chicago, IL 60644
Mailing address
7049 N Kilpatrick Avenue
Lincolnwood, IL 60712
Phone (847) 677-7264
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036051696 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1271116800000",
"number": "1831287887",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7049 N KILPATRICK AVENUE",
"city": "LINCOLNWOOD",
"state": "IL",
"postal_code": "60712",
"telephone_number": "847-677-7264",
"fax_number": "773-379-4034"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4758 WEST WASHINGTON BLVD",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60644",
"telephone_number": "773-379-4348",
"fax_number": "773-379-4034"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICUDINE",
"first_name": "NORMITA",
"middle_name": "MADAMBA",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-11",
"last_updated": "2010-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036051696",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036051696",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.