Provider Demographics
NPI:1982699864
Name:LIPKIN, LORI ANN (DPM)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANN
Last Name:LIPKIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7503 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1481
Mailing Address - Country:US
Mailing Address - Phone:708-366-3770
Mailing Address - Fax:708-366-3740
Practice Address - Street 1:7503 MADISON ST
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-1481
Practice Address - Country:US
Practice Address - Phone:708-366-3770
Practice Address - Fax:708-366-3740
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL60001511OtherBCBSIL
IL750450Medicare ID - Type Unspecified
ILT36986Medicare UPIN