Provider Demographics
NPI:1821240771
Name:LIPAN, MICHAEL JULIAN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JULIAN
Last Name:LIPAN
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 1:4060 PGA BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6570
Mailing Address - Country:US
Mailing Address - Phone:305-799-3151
Mailing Address - Fax:561-776-7113
Practice Address - Street 1:4060 PGA BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6574
Practice Address - Country:US
Practice Address - Phone:561-776-7112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN10571207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology