Provider Demographics
NPI:1619075488
Name:PHILLIPS, MICHAEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:M
Last Name:PHILLIPS
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 1:2021 K ST NW
Mailing Address - Street 2:#412
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006
Mailing Address - Country:US
Mailing Address - Phone:202-785-0666
Mailing Address - Fax:202-833-3998
Practice Address - Street 1:2021 K ST NW
Practice Address - Street 2:#412
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006
Practice Address - Country:US
Practice Address - Phone:202-785-0666
Practice Address - Fax:202-833-3998
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC6374207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C62550Medicare UPIN
DC408875Medicare ID - Type Unspecified