Healthcare Provider Details

I. General information

NPI: 1942293501
Provider Name (Legal Business Name): MIRCEA B LIPOVAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 MEDICAL CIR
MOREHEAD KY
40351-1179
US

IV. Provider business mailing address

PO BOX 766
MOREHEAD KY
40351-0766
US

V. Phone/Fax

Practice location:
  • Phone: 606-783-6500
  • Fax:
Mailing address:
  • Phone: 866-871-7657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number26831
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: