Provider Demographics
NPI:1083661847
Name:SHEREE B LIPKIS, MD SC
Entity type:Organization
Organization Name:SHEREE B LIPKIS, MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEREE
Authorized Official - Middle Name:B
Authorized Official - Last Name:LIPKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-729-0400
Mailing Address - Street 1:2608 PATRIOT BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8024
Mailing Address - Country:US
Mailing Address - Phone:847-729-0400
Mailing Address - Fax:847-730-5733
Practice Address - Street 1:2150 PFINGSTEN RD
Practice Address - Street 2:SUITE 2200
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026
Practice Address - Country:US
Practice Address - Phone:847-729-0400
Practice Address - Fax:847-730-5733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063206207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL547460OtherMEDICARE ID#
IL1083661847OtherNPI