=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326130592
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HOWARD DAVID LIPKIN D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 08/04/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2300 GENOA BUSINESS PARK DR SUITE 220
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48114-7367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-220-4422
-----------------------------------------------------
Fax | 810-225-4696
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6888 GRAND RIVER RD SUITE 220
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48114-9345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-220-4422
-----------------------------------------------------
Fax | 810-225-4696
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 5101011598
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------