Provider Demographics
NPI:1104820802
Name:LIPTAKOVA, HELENA HELGA (MD)
Entity type:Individual
Prefix:
First Name:HELENA
Middle Name:HELGA
Last Name:LIPTAKOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 593
Mailing Address - Street 2:
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-0593
Mailing Address - Country:US
Mailing Address - Phone:304-536-5030
Mailing Address - Fax:304-536-5031
Practice Address - Street 1:9870 GATEWAY BLVD N
Practice Address - Street 2:STE B7
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-4425
Practice Address - Country:US
Practice Address - Phone:915-751-5245
Practice Address - Fax:915-751-5255
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0894208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DR983OtherBCBS
NM00076862Medicaid
TX1213464.05Medicaid
NM00076862Medicaid