Provider Demographics
NPI:1275752255
Name:JEFFREY S. LIPSKY MD PLLC
Entity Type:Organization
Organization Name:JEFFREY S. LIPSKY MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:LIPSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-739-1333
Mailing Address - Street 1:43184 DEQUINDRE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1709
Mailing Address - Country:US
Mailing Address - Phone:586-739-1333
Mailing Address - Fax:586-739-8616
Practice Address - Street 1:43184 DEQUINDRE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1709
Practice Address - Country:US
Practice Address - Phone:586-739-1333
Practice Address - Fax:586-739-8616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062055207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N96670Medicare ID - Type Unspecified