Provider Demographics
NPI:1598703910
Name:LIPPMAN, CALEB R (MD)
Entity Type:Individual
Prefix:DR
First Name:CALEB
Middle Name:R
Last Name:LIPPMAN
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 1:3805B SPRING ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1641
Mailing Address - Country:US
Mailing Address - Phone:262-687-8322
Mailing Address - Fax:262-687-6107
Practice Address - Street 1:3805B SPRING ST
Practice Address - Street 2:SUITE 320
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53405-1641
Practice Address - Country:US
Practice Address - Phone:262-687-8322
Practice Address - Fax:262-687-6107
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059338A207T00000X
ORMD216447207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN129164100OtherINDIANA DEPT OF LABOR
IN200498420Medicaid
INI15819Medicare UPIN
IN708980FMedicare PIN
IN129164100OtherINDIANA DEPT OF LABOR
IN200498420Medicaid