Healthcare Provider Details

I. General information

NPI: 1578556858
Provider Name (Legal Business Name): JOSEPH H. KIPIKASA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 MCCALLIE AVE
CHATTANOOGA TN
37403-2724
US

IV. Provider business mailing address

902 MCCALLIE AVE
CHATTANOOGA TN
37403-2724
US

V. Phone/Fax

Practice location:
  • Phone: 423-664-4460
  • Fax: 423-664-4224
Mailing address:
  • Phone: 423-664-4460
  • Fax: 423-664-4466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD 26807
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: