Provider Demographics
NPI:1275592503
Name:PHILLIPS, JAMES E (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
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 1:104 S LAKEVIEW ST
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-1947
Mailing Address - Country:US
Mailing Address - Phone:269-651-1471
Mailing Address - Fax:269-651-1101
Practice Address - Street 1:104 S LAKEVIEW ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-1947
Practice Address - Country:US
Practice Address - Phone:269-651-1471
Practice Address - Fax:269-651-1101
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301036791207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103418360Medicaid
MI103418360Medicaid
MIB45650Medicare UPIN
MI0G56212020Medicare PIN