Healthcare Provider Details

I. General information

NPI: 1124724521
Provider Name (Legal Business Name): MITCHELL LIPKE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 N LAKE DR
MILWAUKEE WI
53211-4508
US

IV. Provider business mailing address

2301 N LAKE DR
MILWAUKEE WI
53211-4508
US

V. Phone/Fax

Practice location:
  • Phone: 414-585-1000
  • Fax: 414-585-1113
Mailing address:
  • Phone: 414-585-1000
  • Fax: 414-585-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: