MEDICARE: DR. JOHN DAVID LIPSON M.D.

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	208600000X	Surgery Physician	0102313	IN

General Provider Information

NPI Number	:	1568793164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN DAVID LIPSON M.D.

Provider Business Mailing Address
First Line	:	12945 E 100 N
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-9601
Country	:	US
Telephone Number	:	812-579-9024
Fax Number	:

Provider Business Practice Location Address
First Line	:	12945 E 100 N
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-9601
Country	:	US
Telephone Number	:	812-579-9024
Fax Number	:

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

Provider Enumeration Date	:	01/20/2010
Last Update Date	:	01/20/2010

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