Provider Demographics
NPI:1083640734
Name:LIPOWICH, ALEX B (MD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:B
Last Name:LIPOWICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BIESTERFIELD RD
Mailing Address - Street 2:SUITE 2004
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3311
Mailing Address - Country:US
Mailing Address - Phone:847-437-9505
Mailing Address - Fax:847-981-5572
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:SUITE 2004
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3311
Practice Address - Country:US
Practice Address - Phone:847-437-9505
Practice Address - Fax:847-981-5572
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1622277OtherBLUE CROSS BLUE SHIELD
ILF80913Medicare UPIN
IL1622277OtherBLUE CROSS BLUE SHIELD