Provider Demographics
NPI:1225145428
Name:SIPES, DONALD R (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:R
Last Name:SIPES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DONALD
Other - Middle Name:RALPH
Other - Last Name:SIPES
Other - Suffix:
Other - Last Name Type:Doing Business As
Other - Credentials:
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:920-288-8400
Mailing Address - Fax:920-288-8463
Practice Address - Street 1:2845 GREENBRIER RD
Practice Address - Street 2:#430
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54308-8900
Practice Address - Country:US
Practice Address - Phone:920-288-8400
Practice Address - Fax:920-288-8462
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34379207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31934000Medicaid
WI31934000Medicaid
BS3666673OtherDEA NUMBER
74400003Medicare ID - Type UnspecifiedMEDICARE PROVIDER