Provider Demographics
NPI:1780658732
Name:PHILLIPS, EDUARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:MANAGED CARE DEPT
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:28500 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2936
Practice Address - Country:US
Practice Address - Phone:248-865-2575
Practice Address - Fax:248-865-2590
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2011-05-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301032927208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4192657Medicaid
MI123104OtherCARE CHOICES HMO PROV. #
MI22188OtherHEALTH PLAN OF MICHIGAN
MIQMXPR0017577OtherMOLINA HEALTHCARE
MI121731OtherGREAT LAKES HEALTH PLAN
MIB44679Medicare UPIN
MI4192657Medicaid