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1174643845
KEVIN JAMES LICKENBROCK
SAINT LOUIS, MO
NPI
1174643845
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: MO 100453)
Enumeration Date
2007-03-29
Last Update Date
2007-07-08
Business Address
-- KEVIN JAMES LICKENBROCK M.D.
2900 LEMAY FERRY RD SUITE 100
SAINT LOUIS, MO 63125-3900
Phone number: 314-543-5294
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Mailing Address
-- KEVIN JAMES LICKENBROCK M.D.
1159 ALBANY CT
SAINT LOUIS, MO 63119-4733
Phone number: 314-961-4098
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