MEDICARE: DR. JONATHAN JOSEPH LIPMAN PHD MIBIOL CNS

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	133N00000X	Nutritionist	164.004044	IL

General Provider Information

NPI Number	:	1447325634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN JOSEPH LIPMAN PHD MIBIOL CNS

Provider Business Mailing Address
First Line	:	150 HAWK RDG
Second Line	:
City	:	UNICOI
State	:	TN
Zip	:	37692-4374
Country	:	US
Telephone Number	:	423-743-5300
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 HAWK RDG
Second Line	:
City	:	UNICOI
State	:	TN
Zip	:	37692-4374
Country	:	US
Telephone Number	:	423-743-5300
Fax Number	:

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

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	08/30/2013

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