Individual
JAY I LIPOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8316 EXPRESS DR, MARION, IL 62959-5895
(618) 998-8447
(618) 998-9787
Mailing address
8316 EXPRESS DR, MARION, IL 62959-5895
(618) 998-8447
(618) 998-9787
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036099740
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036099740I
—
IL
Enumeration date
08/09/2005
Last updated
12/22/2009
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