Provider Demographics
NPI:1073565545
Name:IPPOLITO, JOHN J (JOHN J IPPOLITO MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:IPPOLITO
Suffix:
Gender:M
Credentials:JOHN J IPPOLITO MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:J
Other - Last Name:IPPOLITO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JOHN J IPPOLITO MD
Mailing Address - Street 1:PO BOX 433
Mailing Address - Street 2:
Mailing Address - City:FOX RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60021-0433
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:77 N AIRLITE ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4912
Practice Address - Country:US
Practice Address - Phone:847-695-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085385207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology