Provider Demographics
NPI:1568872752
Name:PHILLIPPI, ERIC T (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:T
Last Name:PHILLIPPI
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 1:1920 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2027
Mailing Address - Country:US
Mailing Address - Phone:608-251-6060
Mailing Address - Fax:608-251-3930
Practice Address - Street 1:1920 MONROE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711
Practice Address - Country:US
Practice Address - Phone:608-251-6060
Practice Address - Fax:608-251-3930
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI64962-20207Q00000X
WI5510-851207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100047737Medicaid