Healthcare Provider Details

I. General information

NPI: 1174462899
Provider Name (Legal Business Name): MICHAEL PHILLIPI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14850 ROSCOE BLVD
PANORAMA CITY CA
91402-4618
US

IV. Provider business mailing address

1915 OCEAN WAY APT 227
SANTA MONICA CA
90405-1065
US

V. Phone/Fax

Practice location:
  • Phone: 503-320-2898
  • Fax:
Mailing address:
  • Phone: 503-320-2898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: