Provider Demographics
NPI:1508216805
Name:LICK, ADAM NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:NICHOLAS
Last Name:LICK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8086
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-1297
Mailing Address - Fax:314-454-5550
Practice Address - Street 1:4901 FOREST PARK AVE
Practice Address - Street 2:STE 241, MS 90-75-555
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1495
Practice Address - Country:US
Practice Address - Phone:314-362-5060
Practice Address - Fax:314-362-6959
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2021-05-19
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Provider Licenses
StateLicense IDTaxonomies
MO2018032431207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine