MEDICARE: BRUCE LIPSCHUTZ D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	OS5633	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225038706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE LIPSCHUTZ D.O.

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE FL 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9342
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:	239-599-2612

Provider Business Practice Location Address
First Line	:	13691 METRO PKWY STE 110B
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4348
Country	:	US
Telephone Number	:	239-236-7780
Fax Number	:	239-236-7781

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	06/10/2019

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