Provider Demographics
NPI:1366655870
Name:PHILLIPS, KAREN DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:DIANE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 KATY MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-8720
Mailing Address - Country:US
Mailing Address - Phone:803-767-3814
Mailing Address - Fax:
Practice Address - Street 1:1149 KATY MEADOW CT
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-8720
Practice Address - Country:US
Practice Address - Phone:803-767-3814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18707208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery