Provider Demographics
NPI:1699949578
Name:CARL E. LIPNIK, MD PC
Entity type:Organization
Organization Name:CARL E. LIPNIK, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:LIPNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-421-2840
Mailing Address - Street 1:31610 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1932
Mailing Address - Country:US
Mailing Address - Phone:734-421-2840
Mailing Address - Fax:734-421-4045
Practice Address - Street 1:31610 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1932
Practice Address - Country:US
Practice Address - Phone:734-421-2840
Practice Address - Fax:734-421-4045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILL048668207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID83198Medicare UPIN