Provider Demographics
NPI:1942570742
Name:RANDEE E LIPMAN M D P A
Entity Type:Organization
Organization Name:RANDEE E LIPMAN M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDEE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LIPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-263-5889
Mailing Address - Street 1:PO BOX 47641
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-7641
Mailing Address - Country:US
Mailing Address - Phone:316-263-5889
Mailing Address - Fax:316-263-1086
Practice Address - Street 1:1515 S CLIFTON AVE STE 320
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2953
Practice Address - Country:US
Practice Address - Phone:316-263-5889
Practice Address - Fax:316-263-5889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS23573207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA2454OtherBLUE CROSS BLUE SHIELD OF KANSAS
KS100125840GMedicaid
KS100125840GMedicaid
KSKA2454Medicare PIN