Provider Demographics
NPI:1659451060
Name:HIPPLER, STEPHEN
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:HIPPLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 N ROUTE 91
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615
Mailing Address - Country:US
Mailing Address - Phone:309-683-5050
Mailing Address - Fax:309-683-5335
Practice Address - Street 1:8600 N ROUTE 91
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615
Practice Address - Country:US
Practice Address - Phone:309-683-5050
Practice Address - Fax:309-683-5335
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL809840Medicare ID - Type UnspecifiedGROUP #
ILC48857Medicare UPIN
ILL27542Medicare ID - Type UnspecifiedINDIVIDUAL #
IL815990Medicare ID - Type UnspecifiedGROUP #
IL110232382 / CA4079Medicare ID - Type UnspecifiedRR
ILL71844Medicare ID - Type UnspecifiedINDIVIDUAL #