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General NPI Number Information
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NPI Number | 1750657821
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Entity Type | Organization
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Legal Business Name | JACQUELINE PHILLIPS DPM INC
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Dates
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Enumeration Date | 03/22/2012
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Last Update Date | 03/22/2012
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Provider Practice Location Address
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Address Line | 5575 CONNER ST SUITE 203
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City | DETROIT
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State | MI
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Zip | 48213-6400
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Country | US
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Telephone | 313-345-4449
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Fax | 313-499-8341
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Provider Business Mailing Address
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Address Line | 5575 CONNER ST SUITE 203
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City | DETROIT
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State | MI
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Zip | 48213-6400
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Country | US
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Telephone | 313-345-4449
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Fax | 313-499-8341
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Authorized Official
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Title or Position | PRESIDENT
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Name | JACQUELINE PHILLIPS
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Credential | DPM
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Telephone | 313-345-4449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 5901001422
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License Number State | MI
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