Provider Demographics
NPI:1285631374
Name:LIPOV, EUGENE G (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:G
Last Name:LIPOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 W HIGGINS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-2431
Mailing Address - Country:US
Mailing Address - Phone:847-608-6620
Mailing Address - Fax:847-742-5135
Practice Address - Street 1:2260 W HIGGINS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-2431
Practice Address - Country:US
Practice Address - Phone:847-608-6620
Practice Address - Fax:847-742-5135
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071840207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL131846500OtherDEPARTMENT OF LABOR
IL363756275OtherTAX ID
IL1619628OtherBCBS PROVIDER #
IL050041556Medicare ID - Type UnspecifiedRAILROAD MEDICARE
IL363756275OtherTAX ID
IL1619628OtherBCBS PROVIDER #
ILL33646Medicare ID - Type UnspecifiedLOCALITY 16 PIN