Provider Demographics
NPI:1841002334
Name:LIPMAN, DAVID SAMUEL
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SAMUEL
Last Name:LIPMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 E JOHNSON ST APT 113
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3941
Mailing Address - Country:US
Mailing Address - Phone:608-239-4549
Mailing Address - Fax:
Practice Address - Street 1:802 E GORHAM ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-1524
Practice Address - Country:US
Practice Address - Phone:608-239-4549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
WI171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator