Doctor Name: | HAYLEY LIPTAK |
NPI Number: | 1467866673 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 125.065260 |
Business Practice Address: | 180 S 3rd St Suite 400 Belleville, IL - 622201952 |
Business Phone Number: | 6182337880 |
Business Fax Number: | |
Mailing Address: | 2829 Smokehouse Way, BELLEVILLE |
State: | IL |
Postal Code: | 622217031 |
Phone Number: | 8156747599 |
Fax Number: | |
NPI Enumeration Date: | 06/16/2014 |
NPI Last Update Date: | 06/16/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 125.065260 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |