Provider Demographics
NPI:1710011291
Name:PHILLIPS, DENNIS B (DO)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:B
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3528
Mailing Address - Country:US
Mailing Address - Phone:920-457-0318
Mailing Address - Fax:
Practice Address - Street 1:601 REED AVE
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-2026
Practice Address - Country:US
Practice Address - Phone:920-793-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI341162083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIC59352Medicare UPIN
WI014638020Medicare ID - Type Unspecified