Provider Demographics
NPI:1528065448
Name:HULICK, PETER R (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:R
Last Name:HULICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 TOWER DR UNIT 322
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-7810
Mailing Address - Country:US
Mailing Address - Phone:617-312-9747
Mailing Address - Fax:
Practice Address - Street 1:4623 75TH ST # 338
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-3707
Practice Address - Country:US
Practice Address - Phone:617-312-9747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010283582085R0001X
PA0154962085R0001X
WI52899-0202085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA35659OtherHARVARD PILGRIM
MA470301OtherTUFTS
MAAA35659OtherHARVARD PILGRIM
MAA38184Medicare ID - Type Unspecified