MEDICARE: JEFFREY LIPSMAN PA-C

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1326690363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY LIPSMAN PA-C

Provider Business Mailing Address
First Line	:	41735 FOSTER DR UNIT 101
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48375-1977
Country	:	US
Telephone Number	:	860-869-0582
Fax Number	:

Provider Business Practice Location Address
First Line	:	15200 GRATIOT AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48205-1327
Country	:	US
Telephone Number	:	313-924-8495
Fax Number	:

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

Provider Enumeration Date	:	07/10/2019
Last Update Date	:	07/13/2020

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Directions to “ JEFFREY LIPSMAN PA-C” Practice Location

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