Healthcare Provider Details

I. General information

NPI: 1992706428
Provider Name (Legal Business Name): SCOTT E PHILLIPS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12188A N MERIDIAN ST SUITE 375
CARMEL IN
46032-4578
US

IV. Provider business mailing address

12188A N MERIDIAN ST SUITE 375
CARMEL IN
46032-4578
US

V. Phone/Fax

Practice location:
  • Phone: 317-926-1056
  • Fax: 317-579-0476
Mailing address:
  • Phone: 317-926-1056
  • Fax: 317-579-0476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number01049360
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number01049360
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: