Provider Demographics
NPI:1861488439
Name:SIPPO, WILLIAM C (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:SIPPO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1101 WEBER RD
Mailing Address - Street 2:UITE 205
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-3352
Mailing Address - Country:US
Mailing Address - Phone:573-756-8400
Mailing Address - Fax:573-756-8403
Practice Address - Street 1:1101 WEBER RD
Practice Address - Street 2:SUITE 205
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3352
Practice Address - Country:US
Practice Address - Phone:573-756-8400
Practice Address - Fax:573-756-8403
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2011-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036091851208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371352599001Medicaid
G16468Medicare UPIN
ILK17502Medicare Oscar/Certification
IL371352599001Medicaid