Provider Demographics
NPI:1003131657
Name:PHELPS, PAUL OWEN (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:OWEN
Last Name:PHELPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2001 N HALSTED ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4365
Mailing Address - Country:US
Mailing Address - Phone:312-888-5754
Mailing Address - Fax:847-657-1860
Practice Address - Street 1:2001 N HALSTED ST STE 200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4365
Practice Address - Country:US
Practice Address - Phone:312-888-5754
Practice Address - Fax:833-989-2458
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.131388207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery