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NPI Code Detail

MEDICARE: DR. SCOTT BRENT PHILLIPS MD

MEDICARE: DR. SCOTT BRENT PHILLIPS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician036087861IL

General Provider Information

NPI Number : 1053369967
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SCOTT BRENT PHILLIPS MD
Provider Business Mailing Address
First Line : 400 E RANDOLPH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60601-5037
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1431 N CLAREMONT AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60622-1702
Country : US
Telephone Number : 312-633-5857
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 04/01/2021

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Directions to “ DR. SCOTT BRENT PHILLIPS MD” Practice Location

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