Healthcare Provider Details

I. General information

NPI: 1710470091
Provider Name (Legal Business Name): PHILLIP BEHRENS IV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10455 ORTHOPAEDIC DR
NEWBURGH IN
47630-7955
US

IV. Provider business mailing address

515 READ ST
EVANSVILLE IN
47710-1739
US

V. Phone/Fax

Practice location:
  • Phone: 812-424-9291
  • Fax: 812-421-2722
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number57387
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA155439
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01087322A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: