Provider Demographics
NPI:1235350695
Name:PHILLIPS PODIATRY CORP.
Entity Type:Organization
Organization Name:PHILLIPS PODIATRY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:KAHLE
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:760-773-3338
Mailing Address - Street 1:74090 EL PASEO STE 100
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4135
Mailing Address - Country:US
Mailing Address - Phone:760-773-3338
Mailing Address - Fax:760-779-8242
Practice Address - Street 1:74090 EL PASEO STE 100
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4135
Practice Address - Country:US
Practice Address - Phone:760-773-3338
Practice Address - Fax:760-779-8242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3631213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty