Provider Demographics
NPI:1457844433
Name:LIPSEY, DONALD LEWIS (MD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:LEWIS
Last Name:LIPSEY
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 1:16428 84TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-1822
Mailing Address - Country:US
Mailing Address - Phone:763-420-5419
Mailing Address - Fax:
Practice Address - Street 1:16428 84TH AVE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-1822
Practice Address - Country:US
Practice Address - Phone:763-420-5419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM74-75208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice