Healthcare Provider Details

I. General information

NPI: 1720068646
Provider Name (Legal Business Name): DONALD MICHAEL PHILLIPS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1356 S LAKE PARK AVE
HOBART IN
46342-5964
US

IV. Provider business mailing address

1356 S LAKE PARK AVE
HOBART IN
46342-5964
US

V. Phone/Fax

Practice location:
  • Phone: 219-942-8518
  • Fax: 219-947-2751
Mailing address:
  • Phone: 219-942-8518
  • Fax: 219-947-2751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01020846A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: