Healthcare Provider Details

I. General information

NPI: 1932445012
Provider Name (Legal Business Name): MICHAEL D PHILLIPS, MD MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 W OLYMPIC BLVD SUITE 201
LOS ANGELES CA
90006-2998
US

IV. Provider business mailing address

2560 W OLYMPIC BLVD SUITE 201
LOS ANGELES CA
90006-2998
US

V. Phone/Fax

Practice location:
  • Phone: 213-383-0007
  • Fax: 866-505-1544
Mailing address:
  • Phone: 213-383-0007
  • Fax: 866-505-1544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC32413
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC32413
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberC32413
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL D PHILLIPS
Title or Position: PRESIDENT
Credential: MD
Phone: 310-701-9497