Provider Demographics
NPI:1134198583
Name:LIPPELMAN, JOHN P (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:LIPPELMAN
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 1:508 S HABANA AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4181
Mailing Address - Country:US
Mailing Address - Phone:813-870-0207
Mailing Address - Fax:813-876-0303
Practice Address - Street 1:508 S HABANA AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4181
Practice Address - Country:US
Practice Address - Phone:813-870-0207
Practice Address - Fax:813-876-0303
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043646174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068739100Medicaid
FLE14691Medicare UPIN
FL068739100Medicaid