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General NPI Number Information
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NPI Number | 1891934634
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Entity Type | Individual
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Provider Name | MARK A PHILIPS D.O.
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Gender | Male
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 05/19/2022
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Provider Practice Location Address
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Address Line | 252 MCHENRY ST
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City | BURLINGTON
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State | WI
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Zip | 53105-1828
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Country | US
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Telephone | 262-767-6100
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Fax | 262-767-6098
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Provider Business Mailing Address
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Address Line | 252 MCHENRY ST
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City | BURLINGTON
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State | WI
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Zip | 53105-1828
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Country | US
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Telephone | 262-767-6100
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Fax | 262-767-6098
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036122532
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 53736
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License Number State | WI
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