MEDICARE: DR. JOHN M LIPKA 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	1021611	LA
2	207P00000X	Emergency Medicine Physician	1021611	LA

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

General Provider Information

NPI Number	:	1811972284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN M LIPKA M.D.

Provider Business Mailing Address
First Line	:	425 S VINE ST
Second Line	:
City	:	BASTROP
State	:	LA
Zip	:	71220-4513
Country	:	US
Telephone Number	:	318-281-5422
Fax Number	:	318-281-4416

Provider Business Practice Location Address
First Line	:	425 S VINE ST
Second Line	:
City	:	BASTROP
State	:	LA
Zip	:	71220-4513
Country	:	US
Telephone Number	:	318-281-5422
Fax Number	:	318-281-4416

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

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	09/12/2016

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Directions to “ DR. JOHN M LIPKA M.D.” Practice Location

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