Healthcare Provider Details

I. General information

NPI: 1447243605
Provider Name (Legal Business Name): CASIMIR E LIPINSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 W TALCOTT SUITE 262
CHICAGO IL
60631-3745
US

IV. Provider business mailing address

7447 W TALBOTT SUITE 262
CHICAGO IL
60631-3745
US

V. Phone/Fax

Practice location:
  • Phone: 773-775-1900
  • Fax: 773-775-8034
Mailing address:
  • Phone: 773-775-1900
  • Fax: 773-775-8034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number36060744
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: