Provider Demographics
NPI:1558405589
Name:SCHILLER, PHILIP JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JEFFREY
Last Name:SCHILLER
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 1:1612 BLACKHAWK LAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1246
Mailing Address - Country:US
Mailing Address - Phone:651-405-0241
Mailing Address - Fax:
Practice Address - Street 1:1612 BLACKHAWK LAKE PL
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1200
Practice Address - Country:US
Practice Address - Phone:651-405-0241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20489207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNE78849Medicare UPIN