Provider Demographics
NPI:1235343302
Name:MORRIS J LIPNIK MD PA
Entity Type:Organization
Organization Name:MORRIS J LIPNIK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:LIPNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-498-2207
Mailing Address - Street 1:PO BOX 1783
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32756-1783
Mailing Address - Country:US
Mailing Address - Phone:877-277-7077
Mailing Address - Fax:734-789-9152
Practice Address - Street 1:27730 RIVERWALK WAY
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-8691
Practice Address - Country:US
Practice Address - Phone:239-498-2207
Practice Address - Fax:239-498-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2016-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 033321207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDG7069OtherRAILROAD MEDICARE
FLK4948Medicare PIN
FLAH176ZMedicare PIN
FLAJ949ZMedicare PIN
FLK4948OtherMEDICARE GROUP PIN
FLH0847ZMedicare PIN
FL32621ZMedicare PIN
FLA76753Medicare UPIN
FLDG7069Medicare PIN
FL32621OtherBCBS FLORIDA
FL070013154OtherRAILROAD MEDICARE
FLVH060OtherBCBS NEW NUMBER FROM BC
FL070013154Medicare PIN
FLQ71096Medicare UPIN