Provider Demographics
NPI:1851062194
Name:BRUCE J LIPPMANN MD LLC
Entity type:Organization
Organization Name:BRUCE J LIPPMANN MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LIPPMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-313-4314
Mailing Address - Street 1:1209 S. BIG BEND BLVD.
Mailing Address - Street 2:# 179106
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1645
Mailing Address - Country:US
Mailing Address - Phone:573-267-2318
Mailing Address - Fax:
Practice Address - Street 1:1009 EXECUTIVE PKWY DRIVE
Practice Address - Street 2:
Practice Address - City:CREVE CENTER
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:573-267-2318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty