Provider Demographics
NPI:1508957853
Name:KIPFERL, ROBERT S (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:KIPFERL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 NORTHWEST HWY
Mailing Address - Street 2:SUITE G6
Mailing Address - City:FOX RIVER GRV
Mailing Address - State:IL
Mailing Address - Zip Code:60021-1925
Mailing Address - Country:US
Mailing Address - Phone:847-639-2525
Mailing Address - Fax:847-639-2522
Practice Address - Street 1:912 NORTHWEST HWY
Practice Address - Street 2:SUITE G6
Practice Address - City:FOX RIVER GRV
Practice Address - State:IL
Practice Address - Zip Code:60021-1925
Practice Address - Country:US
Practice Address - Phone:847-639-2525
Practice Address - Fax:847-639-2522
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1177860001Medicare NSC