Healthcare Provider Details

I. General information

NPI: 1184618662
Provider Name (Legal Business Name): MARIE K PHILOBOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 S HIGHLAND AVE STE 130
LOMBARD IL
60148-4932
US

IV. Provider business mailing address

1860 PAYSPHERE CIR
CHICAGO IL
60674-1510
US

V. Phone/Fax

Practice location:
  • Phone: 630-627-4722
  • Fax:
Mailing address:
  • Phone: 630-469-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-087552
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: