Provider Demographics
NPI:1023046430
Name:PILEGGI, PHILLIP V (DO)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:V
Last Name:PILEGGI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2500 W UTOPIA RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4171
Mailing Address - Country:US
Mailing Address - Phone:602-214-6148
Mailing Address - Fax:602-214-6149
Practice Address - Street 1:18404 N TATUM BLVD
Practice Address - Street 2:STE. 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-1510
Practice Address - Country:US
Practice Address - Phone:602-992-1900
Practice Address - Fax:602-485-7450
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ3889207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ779613Medicaid
H87732Medicare UPIN
AZ779613Medicaid
AZZ136929Medicare PIN