Provider Demographics
NPI:1275590887
Name:PHILLIPS, DENNIS G (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:G
Last Name:PHILLIPS
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:PO BOX 8035
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-0035
Mailing Address - Country:US
Mailing Address - Phone:316-689-9135
Mailing Address - Fax:316-689-9667
Practice Address - Street 1:1900 N AMIDON AVE
Practice Address - Street 2:STE 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2125
Practice Address - Country:US
Practice Address - Phone:316-832-9024
Practice Address - Fax:316-832-9478
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-21472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
003719192OtherMEDICARE
KS100120280EMedicaid
KS100120280EMedicaid