DAVID J LICINI (NPI# 1801086343) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801086343 |
| Entity Type | Individual |
| Full Name | DAVID J LICINI |
| Credential | MD |
| Practice Address |
1302 S Rogers St Bloomington IN 47403-4752 |
| Mailing Address |
Po Box 1329 Bloomington IN 47402-1329 |
| Practice Telephone | 8123332663 |
| Practice Fax Number | 8126764131 |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2018-11-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207X00000X | Orthopaedic Surgery | 01071339A | IN | Allopathic & Osteopathic Physicians |
| N | 207XS0114X |
Orthopaedic Surgery Specialization: Adult Reconstructive Orthopaedic Surgery |
01071339A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 201119230 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2605 E Creeks Edge Dr, Bloomington, IN 474018368 | 8123552300 |
| Street Address |
1302 S ROGERS ST |
| City | BLOOMINGTON |
| State | IN |
| Zip Code | 47403-4752 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487658167 | Lori Ann Thompson | Family Medicine | 1302 S Rogers St, Bloomington, IN 47403 | 2005-06-09 |
| 1588216212 | Luke Throckmorton | Pharmacist | 1302 S Rogers St, Bloomington, IN 47403-4752 | 2019-07-12 |
| 1720647902 | Carrie Lamoureux | Registered Nurse | 1302 S Rogers St, Bloomington, IN 47403-4752 | 2019-06-11 |
| 1053715045 | Vicky Thompson | Nurse Practitioner | 1302 S Rogers St, Bloomington, IN 47403 | 2014-10-20 |
| 1265850432 | Orthopedics of South Central Indiana, LLC | Durable Medical Equipment & Medical Supplies | 1302 S Rogers St, Bloomington, IN 47403-4752 | 2014-04-03 |
| 1619225992 | Cheri M. Towell | Nurse Practitioner | 1302 S Rogers St, Bloomington, IN 47403-4752 | 2012-08-17 |
| 1437411188 | Emily Manlove | Family Medicine | 1302 S Rogers St, Bloomington, IN 47403-4752 | 2012-06-08 |
| 1881978112 | Miala R Oliger | Nurse Practitioner | 1302 S Rogers St, Bloomington, IN 47403-4752 | 2011-10-05 |
| 1043599723 | Susan Glenna Laughlin | Nurse Practitioner | 1302 S Rogers St, Bloomington, IN 47403-4752 | 2011-08-11 |
| 1679881676 | Rachel M O'connor | Nurse Practitioner | 1302 S Rogers St, Bloomington, IN 47403-4752 | 2010-09-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043783673 | Brook Whitaker | Registered Nurse | 4011 S. Monroe Medical Park Blvd, Bloomington, IN 47403 | 2019-01-07 |
| 1598251175 | Jacob Edward Lundorf | Nurse Practitioner | 2100 S Liberty Dr Ste B, Bloomington, IN 47403 | 2018-07-06 |
| 1568973717 | Gregory Thomas Dougan | Physician Assistant | 418 South Landmark Avenue, Bloomington, IN 47403 | 2017-10-16 |
| 1295276160 | Indiana Center for Recovery, LLC | Substance Abuse Rehabilitation Facility | 1004 W 1st Street, Bloomington, IN 47403 | 2017-03-13 |
| 1144694217 | Kayla Dewolf | Specialist/Technologist | 1471 W Allen St, Bloomington, IN 47403 | 2015-11-30 |
| 1164806444 | Monroe Hosoital | General Acute Care Hospital | 4011 Monroe Medical Park, Bloomington, IN 47403 | 2015-07-16 |
| 1821411588 | Jennifer Turner | Occupational Therapy Assistant | 1023 West Main St, Swiss Villa, Vevay, IN 47403 | 2014-01-30 |
| 1104170232 | Kendall Basore | Social Worker | 445 S. Landmark Ave., Bloomington, IN 47403 | 2012-10-26 |
| 1568715886 | Indiana Hearing LLC | Hearing Aid Equipment | 2019 S Liberty Dr, Bloomington, IN 47403 | 2012-10-24 |
| 1679870232 | Accurate Hearing Services | Clinic/Center | 1355 W Second St, #3, Bloomington, IN 47403 | 2011-02-17 |
| Find all providers in zip 47403 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639631526 | Multiple Care of Mn, LLC | Orthopaedic Surgery | 8500 Normandale Lake Blvd Ste 350, Bloomington, MN 55437-3805 | 2019-04-01 |
| 1215046313 | Robert K Seidl | Orthopaedic Surgery | 2406 E. Empire St., Bloomington, IL 61704 | 2006-08-30 |
| 1376599506 | Brian P. Murphy | Orthopaedic Surgery | 3209 W Fullerton Pike Ste A, Bloomington, IN 47403-4060 | 2006-05-26 |
| 1285633420 | Joseph Kaysing Newcomer | Orthopaedic Surgery | 1111 Trinity Lane, Suite 111, Bloomington, IL 61704-3738 | 2005-07-19 |
| 1316582273 | Nicole Christine Bermudes | Orthopaedic Surgery | 1111 Trinity Ln Ste 111, Bloomington, IL 61704-8112 | 2019-11-14 |
| 1194245753 | Orthopaedics-indianapolis, Inc. | Orthopaedic Surgery | 3209 W Fullerton Pike Ste A, Bloomington, IN 47403-4060 | 2017-06-26 |
| 1649676404 | Stefan Turkula | Orthopaedic Surgery | 8100 Northland Dr, Bloomington, MN 55431 | 2014-11-06 |
| 1053759092 | Brandon Royce Hood | Orthopaedic Surgery | 2605 E Creeks Edge Dr, Bloomington, IN 47401-8368 | 2013-06-12 |
| 1669818548 | Jessica Brozek | Orthopaedic Surgery | 8100 Northland Dr, Bloomington, MN 55431 | 2013-05-17 |
| 1851640387 | St. Vincent Medical Group, Inc. | Orthopaedic Surgery | 2605 E Creeks Edge Dr, Bloomington, IN 47401-8368 | 2012-08-30 |
| Find all providers in BLOOMINGTON | ||||
| City | BLOOMINGTON |
| Zip Code | 47403 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.