Provider Demographics
NPI:1093757080
Name:EPSTEIN, PHILLIP S (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:S
Last Name:EPSTEIN
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 1:350 E DUNDEE RD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-3192
Mailing Address - Country:US
Mailing Address - Phone:224-676-0547
Mailing Address - Fax:224-676-0564
Practice Address - Street 1:350 E DUNDEE RD
Practice Address - Street 2:SUITE 315
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-3192
Practice Address - Country:US
Practice Address - Phone:224-676-0547
Practice Address - Fax:224-676-0564
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36391682084N0400X, 2084P0800X
IL0360391682084D0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic Neuroimaging
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE14548Medicare UPIN
IL202073Medicare ID - Type Unspecified