Provider Demographics
NPI:1821354028
Name:PHILLIPS, ANDREW LUKE (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:LUKE
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 1:391 S CHIPETA WAY STE C
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1294
Mailing Address - Country:US
Mailing Address - Phone:801-865-5577
Mailing Address - Fax:
Practice Address - Street 1:391 S CHIPETA WAY STE C
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84108-1294
Practice Address - Country:US
Practice Address - Phone:801-865-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8790830-12052083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty