Provider Demographics
NPI:1104122936
Name:KIPP, MICHAEL DAVID (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:KIPP
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1673
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-7673
Mailing Address - Country:US
Mailing Address - Phone:207-620-7273
Mailing Address - Fax:207-620-7275
Practice Address - Street 1:3 SAINT CATHERINE ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5732
Practice Address - Country:US
Practice Address - Phone:207-620-7273
Practice Address - Fax:207-620-7275
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD1086213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist