Provider Demographics
NPI:1497743181
Name:NORTH SIDE INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:NORTH SIDE INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:LIPRIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-749-1484
Mailing Address - Street 1:6957 NW EXPRESSWAY
Mailing Address - Street 2:SUITE #301
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-3533
Mailing Address - Country:US
Mailing Address - Phone:405-749-1484
Mailing Address - Fax:405-749-1484
Practice Address - Street 1:6957 NW EXPRESSWAY
Practice Address - Street 2:SUITE #301
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-3533
Practice Address - Country:US
Practice Address - Phone:405-749-1484
Practice Address - Fax:405-749-1484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18076261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty