Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 25168 | CA |
N | 175F00000X | Naturopath | 151 | CA |
NPI | 1154463966 |
---|---|
Provider Name | Dr. Michael Jon Lipelt |
First Address | Sebastopol, CA 95472-4262 |
Second Address | Sebastopol, CA 95472-4262 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 08/07/2007 |