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NPI Code Detail

MEDICARE: DR. EDUARDO PHILLIPS M.D.

MEDICARE: DR. EDUARDO 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
1208600000XSurgery Physician4301032927MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2123104OTHERMICARE CHOICES HMO PROV. #
322188OTHERMIHEALTH PLAN OF MICHIGAN
4QMXPR0017577OTHERMIMOLINA HEALTHCARE
5121731OTHERMIGREAT LAKES HEALTH PLAN

General Provider Information

NPI Number : 1780658732
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDUARDO PHILLIPS M.D.
Provider Business Mailing Address
First Line : 2234 COLONIAL BLVD
Second Line : MANAGED CARE DEPT
City : FORT MYERS
State : FL
Zip : 33907-1412
Country : US
Telephone Number : 239-931-7342
Fax Number : 239-931-7385
Provider Business Practice Location Address
First Line : 28500 ORCHARD LAKE RD
Second Line : SUITE 201
City : FARMINGTON HILLS
State : MI
Zip : 48334-2936
Country : US
Telephone Number : 248-865-2575
Fax Number : 248-865-2590
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2006
Last Update Date : 05/24/2011

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