Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | IL |
NPI | 1053470112 |
---|---|
Provider Name | Stephen J Lippitz |
First Address | Palatine, IL 60067-7212 |
Second Address | Palatine, IL 60067-7212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 08/07/2007 |