MEDICARE: BRIAN V 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	207Q00000X	Family Medicine Physician	43101052811	MI

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	:	1558365163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN V PHILLIPS MD

Provider Business Mailing Address
First Line	:	2249 WEALTHY ST SE
Second Line	:	STE 110
City	:	EAST GRAND RAPIDS
State	:	MI
Zip	:	49506-3052
Country	:	US
Telephone Number	:	616-391-4600
Fax Number	:	616-486-0133

Provider Business Practice Location Address
First Line	:	2249 WEALTHY ST SE
Second Line	:	STE 110
City	:	EAST GRAND RAPIDS
State	:	MI
Zip	:	49506-3052
Country	:	US
Telephone Number	:	616-391-4600
Fax Number	:	616-486-0133

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	08/04/2025

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Directions to “ BRIAN V PHILLIPS MD” Practice Location

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