IndividualActive
Alan Licup, MD
NPI 1205048246 · Surgery Physician · Pleasant Prairie, WI
Provider details
- NPI number
- 1205048246
- Entity type
- Individual
- Primary specialty
- Surgery PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- License
- 66270-20 (WI)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Practice location
12500 Aurora Dr
Pleasant Prairie, WI 53158
Phone: (262) 854-5000
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 735044
Chicago, IL 60673-5044
Registry dates
- Enumerated
- 2007-05-03
- Last updated
- 2025-10-07
- Certified
- 2025-10-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.