Basic Information
| Provider Information | |||||||||
| NPI: | 1427406701 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HIPP | ||||||||
| FirstName: | KELLEN | ||||||||
| MiddleName: | GARY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22250 PROVIDENCE DR | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480754825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488493281 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9 HEALTHCARE DR STE 202 | ||||||||
| Address2: | |||||||||
| City: | BIDDEFORD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040059450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072831427 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2016 | ||||||||
| LastUpdateDate: | 07/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | DO3387 | ME | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.