Healthcare Provider Details

I. General information

NPI: 1558349746
Provider Name (Legal Business Name): WILLIAM WALTER PHILLIPS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7870W US HIGHWAY 2
MANISTIQUE MI
49854-8992
US

IV. Provider business mailing address

7870W HWY US2
MANISTIQUE MI
49854-1522
US

V. Phone/Fax

Practice location:
  • Phone: 906-341-2153
  • Fax: 906-341-3299
Mailing address:
  • Phone: 906-341-2153
  • Fax: 906-341-3299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101007415
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101007415
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: