Provider Demographics
NPI:1689354243
Name:LIPTRAP, FREDERICK KEVIN (MED; ED S)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:KEVIN
Last Name:LIPTRAP
Suffix:
Gender:M
Credentials:MED; ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11101 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1813
Mailing Address - Country:US
Mailing Address - Phone:216-721-3030
Mailing Address - Fax:216-202-1066
Practice Address - Street 1:11101 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1813
Practice Address - Country:US
Practice Address - Phone:216-721-3030
Practice Address - Fax:216-202-1066
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator