Provider Demographics
NPI:1548240328
Name:PHILLIPS, OFELIA (MD)
Entity Type:Individual
Prefix:
First Name:OFELIA
Middle Name:
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 1:360 W BUTTERFIELD RD
Mailing Address - Street 2:140
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5068
Mailing Address - Country:US
Mailing Address - Phone:630-834-6246
Mailing Address - Fax:630-834-3355
Practice Address - Street 1:360 W BUTTERFIELD RD
Practice Address - Street 2:140
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5068
Practice Address - Country:US
Practice Address - Phone:630-834-6246
Practice Address - Fax:630-834-3355
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-096952207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL534890Medicare ID - Type Unspecified
IL534890Medicare ID - Type Unspecified