Provider Demographics
NPI:1669498648
Name:ALEX B LIPOWICH MD SC
Entity type:Organization
Organization Name:ALEX B LIPOWICH MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALZAK
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MANAGER
Authorized Official - Phone:847-437-9505
Mailing Address - Street 1:800 BIESTERFIELD RD
Mailing Address - Street 2:SUITE 2004
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3311
Mailing Address - Country:US
Mailing Address - Phone:847-437-9505
Mailing Address - Fax:847-981-5572
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:SUITE 2004
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3311
Practice Address - Country:US
Practice Address - Phone:847-437-9505
Practice Address - Fax:847-981-5572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086690207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1622277OtherBLUE CROSS BLUE SHIELD
IL036086690Medicaid
ILF80913Medicare UPIN