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General NPI Number Information
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NPI Number | 1104981455
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Entity Type | Organization
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Legal Business Name | BRYAN J PHILLIPS MD SC
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 718 S WEBER ROAD
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City | BOLINGBROOK
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State | IL
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Zip | 60490
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Country | US
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Telephone | 630-378-4799
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Fax |
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Provider Business Mailing Address
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Address Line | 718 S WEBER RD
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City | BOLINGBROOK
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State | IL
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Zip | 60490-5472
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Country | US
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Telephone | 630-378-4799
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Fax | 630-378-4783
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MELISSA HOFSTEADTER
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Credential |
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Telephone | 630-378-4799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 036-098037
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License Number State | IL
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