Provider Demographics
NPI:1770531394
Name:LIPKOWITZ, ALLAN (MD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:
Last Name:LIPKOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALLAN
Other - Middle Name:
Other - Last Name:LIPKOWITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11126 N WYNGATE TRCE
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5871
Mailing Address - Country:US
Mailing Address - Phone:414-349-3431
Mailing Address - Fax:262-240-1464
Practice Address - Street 1:11126 N WYNGATE TRCE
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5871
Practice Address - Country:US
Practice Address - Phone:414-349-3431
Practice Address - Fax:262-240-1464
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI393842085R0202X
CAG544762085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Not Answered2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32430400Medicaid
WI32430400Medicaid