Provider Demographics
NPI:1326093576
Name:KUL-LIPSKI, ELEONORA (MD)
Entity Type:Individual
Prefix:
First Name:ELEONORA
Middle Name:
Last Name:KUL-LIPSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7447 W TALCOTT AVE
Mailing Address - Street 2:STE 269
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3718
Mailing Address - Country:US
Mailing Address - Phone:708-456-3500
Mailing Address - Fax:708-453-6907
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:STE 269
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3718
Practice Address - Country:US
Practice Address - Phone:708-456-3500
Practice Address - Fax:708-453-6907
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042616880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
01606450OtherBCBS
IL036089308Medicaid
G13255Medicare UPIN
541960Medicare ID - Type Unspecified