Provider Demographics
NPI:1639135031
Name:LIPAN, EDDIE M (MD)
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:M
Last Name:LIPAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10117 N 92ND ST
Mailing Address - Street 2:STE 102
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4555
Mailing Address - Country:US
Mailing Address - Phone:480-860-0300
Mailing Address - Fax:480-422-4321
Practice Address - Street 1:10117 N 92ND ST
Practice Address - Street 2:STE 102
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4555
Practice Address - Country:US
Practice Address - Phone:480-860-0300
Practice Address - Fax:480-422-4321
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ21830207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ001425656007Medicaid
AZAZ0196640OtherBLUE CROSS BLUE SHIELD
F48338Medicare UPIN
AZZ108423Medicare PIN