MEDICARE: MICHAEL D PHILLIPS, MD MEDICAL CORPORATION

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	207P00000X	Emergency Medicine Physician	C32413	CA
2	207Q00000X	Family Medicine Physician	C32413	CA
3	208VP0000X	Pain Medicine Physician	C32413	CA

General Provider Information

NPI Number	:	1932445012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL D PHILLIPS, MD MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	2560 W OLYMPIC BLVD
Second Line	:	SUITE 201
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2998
Country	:	US
Telephone Number	:	213-383-0007
Fax Number	:	866-505-1544

Provider Business Practice Location Address
First Line	:	2560 W OLYMPIC BLVD
Second Line	:	SUITE 201
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2998
Country	:	US
Telephone Number	:	213-383-0007
Fax Number	:	866-505-1544

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL D PHILLIPS
Credential	:	MD
Telephone Number	:	310-701-9497

Provider Enumeration Date	:	12/18/2012
Last Update Date	:	04/05/2013

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