MEDICARE: MR. JEAN-PAUL LIPTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant		MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A698657500	OTHER	MN	MINNESOTA DEPARTMENT OF HUMAN SERVICES

General Provider Information

NPI Number	:	1134833940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEAN-PAUL LIPTON

Provider Business Mailing Address
First Line	:	1324 JACKSON AVE
Second Line	:
City	:	DETROIT LAKES
State	:	MN
Zip	:	56501-4104
Country	:	US
Telephone Number	:	651-336-2404
Fax Number	:

Provider Business Practice Location Address
First Line	:	1324 JACKSON AVE
Second Line	:
City	:	DETROIT LAKES
State	:	MN
Zip	:	56501-4104
Country	:	US
Telephone Number	:	651-336-2404
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2023
Last Update Date	:	01/06/2023

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Directions to “ MR. JEAN-PAUL LIPTON ” Practice Location

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