Healthcare Provider Details

I. General information

NPI: 1457536435
Provider Name (Legal Business Name): SAM LIPSHITZ SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 W HUBBARD ST
CHICAGO IL
60612-1435
US

IV. Provider business mailing address

7520 SKOKIE BLVD
SKOKIE IL
60077-3342
US

V. Phone/Fax

Practice location:
  • Phone: 847-514-2662
  • Fax:
Mailing address:
  • Phone: 847-514-2662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: DR. SAM LIPSHITZ
Title or Position: OWNER
Credential: MD
Phone: 847-514-2662