Provider Demographics
NPI:1386852580
Name:ROBERT S. STIPEK, D.P.M.
Entity type:Organization
Organization Name:ROBERT S. STIPEK, D.P.M.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:STIPEK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:781-272-5484
Mailing Address - Street 1:265 WINN ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-2616
Mailing Address - Country:US
Mailing Address - Phone:781-272-5484
Mailing Address - Fax:781-272-1616
Practice Address - Street 1:265 WINN ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-2616
Practice Address - Country:US
Practice Address - Phone:781-272-5484
Practice Address - Fax:781-272-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-19
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1455213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY77164OtherBCBS ID