Provider Demographics
NPI:1659480739
Name:LIPSCHULTZ, STEPHEN ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ALAN
Last Name:LIPSCHULTZ
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 1:1515 SHERIDAN RD STE 31A
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1828
Mailing Address - Country:US
Mailing Address - Phone:847-920-2200
Mailing Address - Fax:847-920-2201
Practice Address - Street 1:1515 SHERIDAN RD STE 31A
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1828
Practice Address - Country:US
Practice Address - Phone:847-920-2200
Practice Address - Fax:847-920-2201
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-057892207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL650690Medicare ID - Type Unspecified
ILC44869Medicare UPIN