MEDICARE: NANETTE D PHILLIS, MD, PLLC 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
1	207R00000X	Internal Medicine Physician	195745	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	DE2348	OTHER	NY	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P020195745	OTHER	NY	UNIVERA
2	412186999	OTHER	NY	EMPIRE PLAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	P010195745	OTHER	NY	RMSCO
5	101517BJ	OTHER	NY	PREFERRED CARE
6	5269451	OTHER	NY	AETNA
8	P020195745	OTHER	NY	BCBS OF ROCHESTER
9	412186999	OTHER	GA	UNITED HEALTH CARE

General Provider Information

NPI Number	:	1225004476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANETTE D PHILLIS, MD, PLLC MD

Provider Business Mailing Address
First Line	:	1815 S CLINTON AVE
Second Line	:	SUITE 340
City	:	ROCHESTER
State	:	NY
Zip	:	14618-5720
Country	:	US
Telephone Number	:	585-461-9500
Fax Number	:	585-271-1432

Provider Business Practice Location Address
First Line	:	1815 S CLINTON AVE
Second Line	:	SUITE 340
City	:	ROCHESTER
State	:	NY
Zip	:	14618-5720
Country	:	US
Telephone Number	:	585-461-9500
Fax Number	:	585-271-1432

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	05/03/2010

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