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General NPI Number Information
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NPI Number | 1891081386
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Entity Type | Individual
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Provider Name | CHRISTOPHER M PHILLIPS DPM.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2011
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Last Update Date | 08/30/2024
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Provider Practice Location Address
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Address Line | 4520 CENTERVILLE RD
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55127-3602
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Country | US
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Telephone | 651-426-3995
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Fax | 651-426-5626
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Provider Business Mailing Address
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Address Line | PO BOX 1086
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City | WILLOUGHBY
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State | OH
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Zip | 44096-1086
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Country | US
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Telephone | 216-645-7242
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Fax | 440-975-8278
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 923
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License Number State | MN
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