Provider Demographics
NPI:1073619623
Name:ALBERT, PHILIP RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:RICHARD
Last Name:ALBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 RIB MOUNTAIN WAY
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-9291
Mailing Address - Country:US
Mailing Address - Phone:715-302-0130
Mailing Address - Fax:715-842-4058
Practice Address - Street 1:2705 RIB MOUNTAIN WAY
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-9291
Practice Address - Country:US
Practice Address - Phone:715-302-0130
Practice Address - Fax:715-842-4058
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17796-0202085B0100X
WI177962085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1073619623Medicaid
VA1073619623Medicaid