Organization
INTERNAMED, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SERGEI G LIPOV M.D. (PRESIDENT)
(847) 608-7542
Entity
Organization
Contact information
Practice address
1975 LIN LOR LN, SUITE 285, ELGIN, IL 60123-4902
(847) 608-7542
(847) 608-9812
Mailing address
PO BOX 5478, ELGIN, IL 60121-5478
(847) 608-7542
(847) 608-9812
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036065857
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004527746
BLUE SHIELD
IL
05
—
036065857
—
IL
Enumeration date
07/04/2006
Last updated
02/23/2015
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