LIPSMEYER, CHRISTOPHER P (MD)

Provider Demographics

• NPI: 1164536512
• Name: LIPSMEYER, CHRISTOPHER P (MD)
• Entity Type: Individual
• Prefix: DR
• First Name: CHRISTOPHER
• Middle Name: P
• Last Name: LIPSMEYER
• Gender: M
• Credentials: MD
• Mailing Address - Street 1: PO BOX 8351
• Mailing Address - City: FORT WORTH
• Mailing Address - State: TX
• Mailing Address - Zip Code: 76124-0351
• Mailing Address - Country: US
• Mailing Address - Phone: 817-451-4208
• Practice Address - Street 1: 6800 STATE ROUTE 162
• Practice Address - City: MARYVILLE
• Practice Address - State: IL
• Practice Address - Zip Code: 62062-8500
• Practice Address - Country: US
• Practice Address - Phone: 618-288-5711
• Is Sole Proprietor?: No
• Enumeration Date: 2006-08-19
• Last Update Date: 2023-03-07

Provider Licenses

State	License ID	Taxonomies
IL	36-116105	207P00000X
KS	0432906	207P00000X
OH	35.094674	207P00000X
MO	2006029618	207P00000X
VA	0101246429	207P00000X
WA	MD60132287	207P00000X
AL	MD.32515	207P00000X
MS	22512	207P00000X
TX	Q1440	207P00000X
IA	MD38533	207P00000X
IN	01067277A	207P00000X
KY	45360	207P00000X
LA	303380	207P00000X
MI	4301081397	207P00000X
FL	46236	207P00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	207P00000X	Allopathic & Osteopathic Physicians	Emergency Medicine

Provider Identifiers

State	Identifier ID	ID Type	Issuer
IL	036116105	Medicaid
VA	1164536512	Medicaid
ID	11647536512	Medicaid
KY	7100146810	Medicaid
MO	P00657549	Other	RR MEDICARE
IA	1164536512	Other	BLUE SHIELD
MO	1164536512	Medicaid
FL	68323	Other	BC BS OF FL
IA	1164536512	Medicaid
TN	1521057	Medicaid
KS	200423200D	Medicaid
IL	06032182	Other	BLUE CROSS BLUE SHIELD
WA	1164536512	Medicaid
OH	3006106	Medicaid
FL	000386700	Medicaid
MT	1720253172	Medicaid
KS	1164536512	Other	BCBS
WV	3810018865	Medicaid
WV	3810018865	Medicaid
WA	1164536512	Medicaid
IL	I61971	Medicare UPIN
OH	3006106	Medicaid
IL	036116105	Medicaid
TN	103I931158	Medicare PIN
MO	147480018	Medicare PIN
FL	AS253Y	Medicare PIN
KY	7100146810	Medicaid
FL	000386700	Medicaid
	BL9795824	Other	DEA CERTIFICATE
MO	P00657549	Other	RR MEDICARE
MT	1720253172	Medicaid
IA	1164536512	Medicaid