MEDICARE: DR. LORI ANN LIPKIN D.P.M.

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	213E00000X	Podiatrist		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	60001511	OTHER	IL	BCBSIL

General Provider Information

NPI Number	:	1982699864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORI ANN LIPKIN D.P.M.

Provider Business Mailing Address
First Line	:	7503 MADISON ST
Second Line	:
City	:	FOREST PARK
State	:	IL
Zip	:	60130-1481
Country	:	US
Telephone Number	:	708-366-3770
Fax Number	:	708-366-3740

Provider Business Practice Location Address
First Line	:	7503 MADISON ST
Second Line	:
City	:	FOREST PARK
State	:	IL
Zip	:	60130-1481
Country	:	US
Telephone Number	:	708-366-3770
Fax Number	:	708-366-3740

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	07/08/2007

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