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General NPI Number Information
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NPI Number | 1578720355
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Entity Type | Organization
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Legal Business Name | GEORGE DEPHILLIPS
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 330 MADISON ST STE 202
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City | JOLIET
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State | IL
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Zip | 60435-6565
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Country | US
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Telephone | 815-741-2312
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Fax |
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Provider Business Mailing Address
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Address Line | 330 MADISON ST STE 202
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City | JOLIET
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State | IL
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Zip | 60435-6565
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | GEORGE DEPHILLIPS
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Credential |
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Telephone | 815-741-2312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 036073278
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License Number State | IL
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