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General NPI Number Information
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NPI Number | 1679684344
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Entity Type | Individual
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Provider Name | ANTONIO M PHILLIPS MD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 2872 W BROAD ST
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City | COLUMBUS
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State | OH
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Zip | 43204-2645
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Country | US
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Telephone | 614-279-9905
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Fax | 614-279-0213
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Provider Business Mailing Address
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Address Line | 2872 W BROAD ST
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City | COLUMBUS
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State | OH
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Zip | 43204-2645
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Country | US
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Telephone | 614-279-9905
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Fax | 614-279-0213
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35086067
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License Number State | OH
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