Provider Demographics
NPI:1588949200
Name:JEFFREY A. LIPKE, MD PC
Entity type:Organization
Organization Name:JEFFREY A. LIPKE, MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LIPKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-531-7026
Mailing Address - Street 1:215 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:OSAKIS
Mailing Address - State:MN
Mailing Address - Zip Code:56360-8266
Mailing Address - Country:US
Mailing Address - Phone:970-531-7026
Mailing Address - Fax:
Practice Address - Street 1:3 TEN MILE DRIVE
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CO
Practice Address - Zip Code:80446
Practice Address - Country:US
Practice Address - Phone:970-531-7026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care