Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 49791 | WI |
Y | 207QS0010X | Family Doctor - Sports Medicine | 49791 | WI |
N | 207QS0010X | Family Doctor - Sports Medicine | 49791-021 | WI |
NPI | 1295914299 |
---|---|
Provider Name | Dr. Lincoln Paul Likness |
First Address | Hudson, WI 54016 |
Second Address | Hudson, WI 54016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2007 |
Last Update Date | 07/01/2011 |