Individual
JASON EDWARD KIPPENBROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1120 W MICHIGAN ST # CL642, INDIANAPOLIS, IN 46202-5209
(317) 278-2686
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01085962A
IN
390200000X
Student in an Organized Health Care Education/Training Program
11020051A
IN
Other
Enumeration date
06/13/2018
Last updated
07/13/2021
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