Provider Demographics
NPI:1275553331
Name:WICKS, JAMES M (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:WICKS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2151 WAUKEGAN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1885
Mailing Address - Country:US
Mailing Address - Phone:847-444-5300
Mailing Address - Fax:847-267-0694
Practice Address - Street 1:2151 WAUKEGAN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1885
Practice Address - Country:US
Practice Address - Phone:847-444-5300
Practice Address - Fax:847-267-0694
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-10-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL36047747207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36047747Medicaid
IL110047115OtherRAILROAD MEDICARE
IL04915267OtherBLUE CROSS BLUE SHIELD
ILC38275Medicare UPIN
ILP11836Medicare UPIN
IL36047747Medicaid
ILCB4276Medicare ID - Type UnspecifiedRAILROAD MEDICARE