Basic Information
| Provider Information | |||||||||
| NPI: | 1346432465 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HIPSKIND | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | GREGORY | ||||||||
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| Credential: | MD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4500 MEMORIAL DRIVE- MEDICAL AFFAIR | ||||||||
| Address2: | CREDENTIALING DEPARTMENT | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182574644 | ||||||||
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| Practice Location | |||||||||
| Address1: | 130 LINCOLN PLACE CT | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622215884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182572029 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2007 | ||||||||
| LastUpdateDate: | 12/03/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036126548 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207RG0300X | 036126548 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.