Provider Demographics
NPI:1174854319
Name:LIPSCHUTZ, ROBERT DANIEL (CP)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DANIEL
Last Name:LIPSCHUTZ
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 E SUPERIOR ST
Mailing Address - Street 2:ROOM 1309
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2654
Mailing Address - Country:US
Mailing Address - Phone:312-238-4137
Mailing Address - Fax:312-238-2081
Practice Address - Street 1:345 E SUPERIOR ST
Practice Address - Street 2:ROOM 1309
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2654
Practice Address - Country:US
Practice Address - Phone:312-238-4137
Practice Address - Fax:312-238-2081
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL211.000105224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211.000105OtherSTATE OF ILLINOIS LICENSED PROSTHETIST