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General NPI Number Information
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NPI Number | 1124001938
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Entity Type | Individual
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Provider Name | MICHAEL J PHILLIPS M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/25/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 791 E SUMMIT AVE
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City | OCONOMOWOC
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State | WI
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Zip | 53066-3844
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Country | US
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Telephone | 262-569-0619
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Fax | 262-569-0697
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Provider Business Mailing Address
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Address Line | 6400 INDUSTRIAL LOOP
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City | GREENDALE
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State | WI
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Zip | 53129-2452
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Country | US
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Telephone | 414-423-4100
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Fax | 414-423-4134
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | 20932-020
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License Number State | WI
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