Healthcare Provider Details

I. General information

NPI: 1902071962
Provider Name (Legal Business Name): PHILLIP H MARKOWITZ, D.O., SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 DEMPSTER ST SUITE 150
PARK RIDGE IL
60068-1186
US

IV. Provider business mailing address

1875 DEMPSTER ST SUITE 150
PARK RIDGE IL
60068-1186
US

V. Phone/Fax

Practice location:
  • Phone: 847-692-5010
  • Fax: 847-318-2852
Mailing address:
  • Phone: 847-692-5010
  • Fax: 847-318-2852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number036074864
License Number StateIL

VIII. Authorized Official

Name: DR. PHILLIP H MARKOWITZ
Title or Position: PRESIDENT
Credential: D.O.
Phone: 847-692-5010