Basic Information
| Provider Information | |||||||||
| NPI: | 1891011813 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIPKIN | ||||||||
| FirstName: | GENNA | ||||||||
| MiddleName: | SUZANNE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1030 N CLARK ST FL 4 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606105467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129436964 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1030 N CLARK ST FL 4 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606105467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129436964 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2010 | ||||||||
| LastUpdateDate: | 05/15/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 036131650 | IL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.