MEDICARE: DR. ENRIQUE H LIPEZKER M.D.

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	207V00000X	Obstetrics & Gynecology Physician		IL

General Provider Information

NPI Number	:	1952329948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ENRIQUE H LIPEZKER M.D.

Provider Business Mailing Address
First Line	:	7055 N EAST PRAIRIE RD
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-2542
Country	:	US
Telephone Number	:	847-673-3796
Fax Number	:	847-673-0293

Provider Business Practice Location Address
First Line	:	1522 W CHICAGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-5236
Country	:	US
Telephone Number	:	312-226-2250
Fax Number	:

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/08/2007

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