Provider Demographics
NPI:1558362319
Name:LIPPIE, DAVID S (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:LIPPIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3514
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:7910 W JEFFERSON BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4159
Practice Address - Country:US
Practice Address - Phone:260-969-7121
Practice Address - Fax:260-436-4292
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041216A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00919720OtherRAILROAD MEDICARE
MI104435202Medicaid
IN200318600Medicaid
OH2232828Medicaid
INF19375Medicare UPIN
IN260690A2Medicare PIN
INF19375Medicare UPIN
IN200318600Medicaid
IN020048451OtherMEDICARE RAILROAD
MI104435202Medicaid