Healthcare Provider Details

I. General information

NPI: 1760800544
Provider Name (Legal Business Name): KATIE PHILLIPS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113 BELLEVUE AVE
CINCINNATI OH
45219-3158
US

IV. Provider business mailing address

2830 VICTORY PARKWAY PAYOR ENROLLMENT
CINCINNATI OH
45206-1785
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8400
  • Fax: 513-475-8228
Mailing address:
  • Phone: 513-585-5507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35.140106
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: