MEDICARE: ALLAN L IPPOLITO 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	2086S0129X	Vascular Surgery Physician	AI044692	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0202507492	OTHER	MI	BC/BS OF MICHIGAN
3	C5093	OTHER	MI	M-CARE
4	113784	OTHER	MI	GREAT LAKES HEALTH PLAN
5	B47732	OTHER	MI	HEALTH ALLIANCE PLAN
6	0601232	OTHER	MI	HEALTHPLUS OF MICHIGAN
7	204104	OTHER	MI	MCLAREN HEALTH PLAN/ADVAN
8	120886	OTHER	MI	CARE CHOICE HMO
9	4292691	OTHER	MI	AETNA
10	120886	OTHER	MI	PREFERRED CHOICE PPO
11	382237803107	OTHER	MI	COMMUNITY CHOICE

General Provider Information

NPI Number	:	1700857273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLAN L IPPOLITO M.D.

Provider Business Mailing Address
First Line	:	5020 W BRISTOL RD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-2919
Country	:	US
Telephone Number	:	810-732-1620
Fax Number	:	810-732-8559

Provider Business Practice Location Address
First Line	:	5020 W BRISTOL RD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-2919
Country	:	US
Telephone Number	:	810-732-1620
Fax Number	:	810-732-8559

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

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	11/27/2007

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Directions to “ ALLAN L IPPOLITO M.D.” Practice Location

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