Healthcare Provider Details

I. General information

NPI: 1114183787
Provider Name (Legal Business Name): PREJESH PHILIPS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E CHESTNUT ST SUITE 710
LOUISVILLE KY
40202-5700
US

IV. Provider business mailing address

PO BOX 909
LOUISVILLE KY
40201-0909
US

V. Phone/Fax

Practice location:
  • Phone: 502-583-8303
  • Fax: 502-584-0302
Mailing address:
  • Phone: 502-588-0329
  • Fax: 502-588-0326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number45387
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: