Individual ProviderMatthew LickermanEmergency MedicineAllopathic & Osteopathic PhysiciansPractice Address4201 W Medical Center Dr, Mchenry, IL 60050(815) 759-3100PECOS EnrollmentBased on the most recent information from CMS, provider Matthew Lickerman is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1730292988Provider TypeIndividualFull NameLickerman, MatthewCredentialMDGenderMaleSole ProprietorNoEnumeration Date8/15/2006Last Updated8/10/2018Contact InformationPractice LocationPractice Address4201 W Medical Center Dr, Mchenry, IL 60050Phone(815) 759-3100Fax(815) 363-9044Mailing LocationMailing Address2790 Sandalwood Rd, Buffalo Grove, IL 60089-6645PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207P00000XPrimaryDescriptionEmergency MedicineAllopathic & Osteopathic PhysiciansLicense036107649IllinoisCode2083P0011XDescriptionPreventive MedicineAllopathic & Osteopathic PhysiciansLicenseME107463Florida