Provider Demographics
NPI:1528246675
Name:KIPA, S GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:S
Middle Name:GEORGE
Last Name:KIPA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 E LAFAYETTE BLVD
Mailing Address - Street 2:MAIL CODE 513K
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-2927
Mailing Address - Country:US
Mailing Address - Phone:313-448-1609
Mailing Address - Fax:877-300-6166
Practice Address - Street 1:600 E LAFAYETTE BLVD
Practice Address - Street 2:MAIL CODE 513K
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-2927
Practice Address - Country:US
Practice Address - Phone:313-448-1609
Practice Address - Fax:877-300-6166
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044520207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine