Provider Demographics
NPI:1316941172
Name:LIPIRA, PHILLIP ANTHONY (DPM)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:ANTHONY
Last Name:LIPIRA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005A W SAINT MAARTENS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2989
Mailing Address - Country:US
Mailing Address - Phone:816-364-2338
Mailing Address - Fax:816-364-1003
Practice Address - Street 1:1005A W SAINT MAARTENS DR
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2989
Practice Address - Country:US
Practice Address - Phone:816-364-2338
Practice Address - Fax:816-364-1003
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000361213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP000062470OtherPALMETTO GBA
MO04529022OtherBC/BS OF KC
MO04529022OtherBC/BS OF KC
MOT42460Medicare UPIN
KSQ813074Medicare ID - Type Unspecified