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General NPI Number Information
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NPI Number | 1932445012
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Entity Type | Organization
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Legal Business Name | MICHAEL D PHILLIPS, MD MEDICAL CORPORATION
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Dates
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Enumeration Date | 12/18/2012
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Last Update Date | 04/05/2013
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Provider Practice Location Address
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Address Line | 2560 W OLYMPIC BLVD SUITE 201
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City | LOS ANGELES
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State | CA
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Zip | 90006-2998
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Country | US
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Telephone | 213-383-0007
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Fax | 866-505-1544
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Provider Business Mailing Address
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Address Line | 2560 W OLYMPIC BLVD SUITE 201
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City | LOS ANGELES
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State | CA
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Zip | 90006-2998
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Country | US
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Telephone | 213-383-0007
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Fax | 866-505-1544
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL D PHILLIPS
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Credential | MD
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Telephone | 310-701-9497
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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 | C32413
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C32413
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | C32413
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License Number State | CA
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