Provider Demographics
NPI:1366444705
Name:LIPNIK, LAWRENCE JACOB (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JACOB
Last Name:LIPNIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:31610 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1932
Mailing Address - Country:US
Mailing Address - Phone:734-421-2840
Mailing Address - Fax:734-421-4045
Practice Address - Street 1:31610 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1932
Practice Address - Country:US
Practice Address - Phone:734-421-2840
Practice Address - Fax:734-421-4045
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MILL048668207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0825052OtherB/S
MI0822343OtherRAILROAD MEDICARE
MI110173158OtherRR MEDICARE
MI0822343Medicare PIN
MI110173158OtherRR MEDICARE