Provider Demographics
NPI:1326690363
Name:LIPSMAN, JEFFREY (PA-C)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:LIPSMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41735 FOSTER DR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1977
Mailing Address - Country:US
Mailing Address - Phone:860-869-0582
Mailing Address - Fax:
Practice Address - Street 1:15200 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-1327
Practice Address - Country:US
Practice Address - Phone:313-924-8495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant