Healthcare Provider Details

I. General information

NPI: 1710076567
Provider Name (Legal Business Name): PHILIP A DY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 MEDICAL PARK DR
EFFINGHAM IL
62401
US

IV. Provider business mailing address

PO BOX 25228
DECATUR IL
62525-5228
US

V. Phone/Fax

Practice location:
  • Phone: 217-342-2066
  • Fax: 217-342-2074
Mailing address:
  • Phone: 217-329-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number036097243
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: