Healthcare Provider Details

I. General information

NPI: 1700175494
Provider Name (Legal Business Name): MICHAEL M PHILLIPS M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 K ST NW SUITE 412
WASHINGTON DC
20006-1003
US

IV. Provider business mailing address

2021 K ST NW SUITE 412
WASHINGTON DC
20006-1003
US

V. Phone/Fax

Practice location:
  • Phone: 202-785-0666
  • Fax: 202-833-3998
Mailing address:
  • Phone: 202-785-0666
  • Fax: 202-833-3998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number6374
License Number StateDC

VIII. Authorized Official

Name: DR. MICHAEL M PHILLIPS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 202-785-0606