Provider Demographics
NPI:1407824782
Name:PHILLIPS, KAMI S (MD)
Entity Type:Individual
Prefix:
First Name:KAMI
Middle Name:S
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:250 GREEN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-1396
Mailing Address - Country:US
Mailing Address - Phone:978-630-4455
Mailing Address - Fax:978-669-0046
Practice Address - Street 1:250 GREEN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-1396
Practice Address - Country:US
Practice Address - Phone:978-630-4455
Practice Address - Fax:978-669-0046
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2016-11-08
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Provider Licenses
StateLicense IDTaxonomies
MA157713207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3186342Medicaid
BX8166Medicare PIN
MA3186342Medicaid