Healthcare Provider Details

I. General information

NPI: 1871118430
Provider Name (Legal Business Name): SEAN M KIPP DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 S ADAMS ST
SAINT CROIX FALLS WI
54024-9449
US

IV. Provider business mailing address

235 E STATE ST
SAINT CROIX FALLS WI
54024-4117
US

V. Phone/Fax

Practice location:
  • Phone: 715-483-0241
  • Fax:
Mailing address:
  • Phone: 715-483-3261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1313-25
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1161
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: