Provider Demographics
NPI:1790780609
Name:BEHN, PHILIP S (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:S
Last Name:BEHN
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 1:4885 W SUMMER CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-9595
Mailing Address - Country:US
Mailing Address - Phone:812-327-9282
Mailing Address - Fax:
Practice Address - Street 1:4885 W SUMMER CT
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-9595
Practice Address - Country:US
Practice Address - Phone:812-606-6278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050702A207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200234460Medicaid
G94994Medicare UPIN
INM400021607Medicare PIN
INM400021607Medicare PIN