Provider Demographics
NPI:1730111725
Name:LIPSKI, DAVID ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ANTHONY
Last Name:LIPSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4003 KRESGE WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4652
Mailing Address - Country:US
Mailing Address - Phone:502-897-5139
Mailing Address - Fax:502-896-6218
Practice Address - Street 1:4003 KRESGE WAY STE 300
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4652
Practice Address - Country:US
Practice Address - Phone:502-897-5139
Practice Address - Fax:502-896-6218
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010469612086S0129X
KY280372086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200163900Medicaid
KY64280373Medicaid
KYP00693364Medicare PIN
F07921Medicare UPIN
502704Medicare ID - Type Unspecified