Provider Demographics
NPI:1952329948
Name:LIPEZKER, ENRIQUE H (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:H
Last Name:LIPEZKER
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 1:7055 N EAST PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-2542
Mailing Address - Country:US
Mailing Address - Phone:847-673-3796
Mailing Address - Fax:847-673-0293
Practice Address - Street 1:1522 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5236
Practice Address - Country:US
Practice Address - Phone:312-226-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL484030Medicare ID - Type Unspecified
ILD12908Medicare UPIN