MEDICARE: ANCIL K. PHILIP 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	208600000X	Surgery Physician	54417-20	WI
2	208600000X	Surgery Physician	A147208	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	PHILIANC	OTHER	WI	MERCYCARE INSURANCE
3	1295943884	OTHER	WI	BCBSWI

General Provider Information

NPI Number	:	1295943884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANCIL K. PHILIP MD

Provider Business Mailing Address
First Line	:	PO BOX 845833
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90084-5833
Country	:	US
Telephone Number	:	310-792-3914
Fax Number	:

Provider Business Practice Location Address
First Line	:	2251 W ROSECRANS AVE STE 21
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90222-3860
Country	:	US
Telephone Number	:	424-529-6755
Fax Number	:

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

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	03/01/2022

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Directions to “ ANCIL K. PHILIP MD” Practice Location

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