Licini, David J

Licini, David J is an individual health care provider with primary practice located at 1302 S Rogers St , Bloomington IN 47403-4752. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Adult Reconstructive Orthopaedic Surgery, Allopathic & Osteopathic Physicians / Orthopaedic Surgery. Allopathic & Osteopathic Physicians / Orthopaedic Surgery is his primary health care specialty. Licini, David J can be contacted via phone (812) 333-2663.

Contact Information

Primary practice address
1302 S Rogers St Bloomington IN 47403-4752
Phone: (812) 333-2663
Fax: (812) 676-4131
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adult Reconstructive Orthopaedic Surgery 207XS0114X 01071339A Indiana
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X 01071339A Indiana

Profile Details

NPI number 1801086343
LBN Legal business name Licini, David J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 31st, 2007
Last updated Oct 27th, 2021 - about 3 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 1801086343 NPPES
Indiana MEDICAID 201119230

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