Provider Demographics
NPI:1093799686
Name:SIPPLE, CHRISTOPHER JOHN (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:SIPPLE
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 1:964 W RYAN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BRILLION
Mailing Address - State:WI
Mailing Address - Zip Code:54110-1076
Mailing Address - Country:US
Mailing Address - Phone:920-756-2055
Mailing Address - Fax:
Practice Address - Street 1:964 W RYAN ST
Practice Address - Street 2:SUITE B
Practice Address - City:BRILLION
Practice Address - State:WI
Practice Address - Zip Code:54110-1076
Practice Address - Country:US
Practice Address - Phone:920-756-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41480207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41480OtherLICENSE
WIH28685Medicare UPIN
WI001710020Medicare Oscar/Certification
WI41480OtherLICENSE
WI100200017Medicare Oscar/Certification
WI500010975Medicare Oscar/Certification