MEDICARE: KENNETH 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
1	208200000X	Plastic Surgery Physician	ME176103	FL

General Provider Information

NPI Number	:	1306924022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH PHILLIPS MD

Provider Business Mailing Address
First Line	:	151 SOUTHHALL LN STE 300
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-7172
Country	:	US
Telephone Number	:	866-400-3376
Fax Number	:	407-650-3455

Provider Business Practice Location Address
First Line	:	202 LAKE MIRIAM DR UNIT 1
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-2180
Country	:	US
Telephone Number	:	866-400-3376
Fax Number	:	863-709-0273

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	06/09/2026

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Directions to “ KENNETH PHILLIPS MD” Practice Location

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