Healthcare Provider Details

I. General information

NPI: 1174541825
Provider Name (Legal Business Name): ELEONORA KUL LIPSKI MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 N CUMBERLAND
NORRIDGE IL
60706
US

IV. Provider business mailing address

4900 N CUMBERLAND
NORRIDGE IL
60706
US

V. Phone/Fax

Practice location:
  • Phone: 708-456-3500
  • Fax: 708-453-6907
Mailing address:
  • Phone: 708-456-3500
  • Fax: 708-453-6907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number042616880
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036089308
License Number StateIL

VIII. Authorized Official

Name: ELEONORA KUL LIPSKI
Title or Position: MD
Credential: MD
Phone: 708-456-3500