Provider Demographics
NPI:1083640734
Name:LIPOWICH, ALEX B (MD, SC)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:B
Last Name:LIPOWICH
Suffix:
Gender:M
Credentials:MD, SC
Other - Prefix:DR
Other - First Name:ALEX
Other - Middle Name:B
Other - Last Name:LIPOWICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1630 W CENTRAL RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2407
Mailing Address - Country:US
Mailing Address - Phone:847-394-3553
Mailing Address - Fax:847-394-3574
Practice Address - Street 1:1630 W CENTRAL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2407
Practice Address - Country:US
Practice Address - Phone:847-394-3553
Practice Address - Fax:847-394-3574
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086690207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36-4259441OtherFEIN
IL036086690Medicaid
IL1622277OtherBLUE CROSS BLUE SHIELD