Provider Demographics
NPI:1700857273
Name:IPPOLITO, ALLAN L (MD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:L
Last Name:IPPOLITO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5020 W BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2919
Mailing Address - Country:US
Mailing Address - Phone:810-732-1620
Mailing Address - Fax:810-732-8559
Practice Address - Street 1:5020 W BRISTOL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2919
Practice Address - Country:US
Practice Address - Phone:810-732-1620
Practice Address - Fax:810-732-8559
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIAI0446922086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1430937Medicaid
MI0202507492OtherBC/BS OF MICHIGAN
MIC5093OtherM-CARE
MI113784OtherGREAT LAKES HEALTH PLAN
MIB47732OtherHEALTH ALLIANCE PLAN
MI0601232OtherHEALTHPLUS OF MICHIGAN
MI204104OtherMCLAREN HEALTH PLAN/ADVAN
MI120886OtherCARE CHOICE HMO
MI4292691OtherAETNA
MI120886OtherPREFERRED CHOICE PPO
MI382237803107OtherCOMMUNITY CHOICE
MI113784OtherGREAT LAKES HEALTH PLAN
MI120886OtherPREFERRED CHOICE PPO