Healthcare Provider Details

I. General information

NPI: 1558365163
Provider Name (Legal Business Name): BRIAN V PHILLIPS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2249 WEALTHY ST SE STE 110
EAST GRAND RAPIDS MI
49506-3052
US

IV. Provider business mailing address

2249 WEALTHY ST SE STE 110
EAST GRAND RAPIDS MI
49506-3052
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-4600
  • Fax: 616-486-0133
Mailing address:
  • Phone: 616-391-4600
  • Fax: 616-486-0133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number43101052811
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: