Provider Demographics
NPI:1790788644
Name:SIPE, EILYNN K (MD)
Entity Type:Individual
Prefix:
First Name:EILYNN
Middle Name:K
Last Name:SIPE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SEAGATE STE 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:419-291-2800
Mailing Address - Fax:419-471-5826
Practice Address - Street 1:5700 MONROE ST UNIT 210
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560
Practice Address - Country:US
Practice Address - Phone:419-291-2800
Practice Address - Fax:419-471-5826
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076379S208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2399748Medicaid
MI104502637OtherMICHIGAN MEDICAID
MI104502637OtherMICHIGAN MEDICAID
OHH030120Medicare PIN
OHH85403Medicare UPIN