MEDICARE: DR. MICHAEL JEROME PHILLIPS M.D.

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	207Y00000X	Otolaryngology Physician	38408	NC

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

General Provider Information

NPI Number	:	1417919044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JEROME PHILLIPS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 602522
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-2522
Country	:	US
Telephone Number	:	252-638-2515
Fax Number	:	252-638-8538

Provider Business Practice Location Address
First Line	:	3110 WELLONS BLVD
Second Line	:	SUITE C
City	:	NEW BERN
State	:	NC
Zip	:	28562-5247
Country	:	US
Telephone Number	:	252-638-2515
Fax Number	:	252-638-8538

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	05/16/2014

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