Healthcare Provider Details

I. General information

NPI: 1992200935
Provider Name (Legal Business Name): DAVID CHRISTIAN EDWARDS PHILPOTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 12/12/2023
Certification Date: 02/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE
CHICAGO IL
60637-1443
US

IV. Provider business mailing address

5827 N MAGNOLIA AVE APT 2S
CHICAGO IL
60660-3582
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-1000
  • Fax:
Mailing address:
  • Phone: 281-352-6170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.165651
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number89108
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: