Provider Demographics
NPI:1518189083
Name:DEVENNEY, PHILIPPA M (MD)
Entity Type:Individual
Prefix:
First Name:PHILIPPA
Middle Name:M
Last Name:DEVENNEY
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 1:403 E. 1ST STREET
Mailing Address - Street 2:KATHERINE SHAW BETHEA HOSPITAL
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021
Mailing Address - Country:US
Mailing Address - Phone:815-285-5629
Mailing Address - Fax:815-285-5634
Practice Address - Street 1:403 E. 1ST STREET
Practice Address - Street 2:KATHERINE SHAW BETHEA HOSPITAL
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021
Practice Address - Country:US
Practice Address - Phone:815-285-5629
Practice Address - Fax:815-285-5634
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098532207R00000X
IL036-098532208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG96920Medicare UPIN
IL624660Medicare ID - Type Unspecified
ILF400293176Medicare PIN