Healthcare Provider Details

I. General information

NPI: 1669812939
Provider Name (Legal Business Name): TELEAH PHILLIPS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 JACKSON RD STE 200
ANN ARBOR MI
48103-1889
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DR # J2000
ANN ARBOR MI
48105-9484
US

V. Phone/Fax

Practice location:
  • Phone: 734-761-2581
  • Fax: 734-761-9540
Mailing address:
  • Phone: 734-747-6766
  • Fax: 734-222-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101020720
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: