Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | POD1086 | ME |
NPI | 1104122936 |
---|---|
Provider Name | Dr. Michael David Kipp |
First Address | Voorhees, NJ 08043-7673 |
Second Address | Augusta, ME 04330-5732 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2011 |
Last Update Date | 26/10/2021 |