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NPI Code Detail

MEDICARE: ELLEX ANTHONY PHILLIPS MD

MEDICARE: ELLEX ANTHONY 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
1207Q00000XFamily Medicine Physician01096270AIN
2390200000XStudent in an Organized Health Care Education/Training ProgramIN

General Provider Information

NPI Number : 1093457186
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEX ANTHONY PHILLIPS MD
Provider Business Mailing Address
First Line : 250 N SHADELAND AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-4959
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5177 MCCARTY LN
Second Line :
City : LAFAYETTE
State : IN
Zip : 47905-8764
Country : US
Telephone Number : 765-448-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2022
Last Update Date : 01/07/2026

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Directions to “ ELLEX ANTHONY PHILLIPS MD” Practice Location

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