Provider Demographics
NPI:1174541825
Name:ELEONORA KUL LIPSKI MD SC
Entity type:Organization
Organization Name:ELEONORA KUL LIPSKI MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ELEONORA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUL LIPSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-456-3500
Mailing Address - Street 1:4900 N CUMBERLAND
Mailing Address - Street 2:
Mailing Address - City:NORRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60706
Mailing Address - Country:US
Mailing Address - Phone:708-456-3500
Mailing Address - Fax:708-453-6907
Practice Address - Street 1:4900 N CUMBERLAND
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706
Practice Address - Country:US
Practice Address - Phone:708-456-3500
Practice Address - Fax:708-453-6907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042616880207Q00000X
IL036089308207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
01606450OtherBCBS
IL036089308Medicaid
ILG13255Medicare UPIN
IL541960Medicare PIN