Provider Demographics
NPI:1720019250
Name:FLIPPIN, REGINA (DPM)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:FLIPPIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2528
Mailing Address - Country:US
Mailing Address - Phone:414-444-9242
Mailing Address - Fax:414-444-9252
Practice Address - Street 1:3915 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2528
Practice Address - Country:US
Practice Address - Phone:414-444-9242
Practice Address - Fax:414-444-9252
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI919.25213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09932334OtherBLUE CROSS BLUE SHIELD
WI43241000Medicaid
WI391868935019OtherBLUE CROSS BLUE SHIELD
WIP00426599OtherRAILROAD MEDICARE
WI000101433Medicare PIN
WIU95677Medicare UPIN