MEDICARE: MARK DAVID LIPETZ

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	261QM2500X	Medical Specialty Clinic/Center	10263	HI

General Provider Information

NPI Number	:	1568597235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK DAVID LIPETZ

Provider Business Mailing Address
First Line	:	41 E LIPOA ST STE 22
Second Line	:
City	:	KIHEI
State	:	HI
Zip	:	96753-8148
Country	:	US
Telephone Number	:	808-891-1177
Fax Number	:	808-891-2255

Provider Business Practice Location Address
First Line	:	41 E LIPOA ST STE 22
Second Line	:
City	:	KIHEI
State	:	HI
Zip	:	96753-8148
Country	:	US
Telephone Number	:	808-891-1177
Fax Number	:	808-891-2255

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK D. LIPETZ
Credential	:	M.D.
Telephone Number	:	808-891-1177

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	06/24/2008

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Directions to “MARK DAVID LIPETZ ” Practice Location

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