Provider Demographics
NPI:1891715991
Name:WINTER, PHILLIPS H (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIPS
Middle Name:H
Last Name:WINTER
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 1:577 MICHIGAN AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423
Mailing Address - Country:US
Mailing Address - Phone:616-393-2190
Mailing Address - Fax:606-393-0147
Practice Address - Street 1:577 MICHIGAN AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423
Practice Address - Country:US
Practice Address - Phone:616-393-2190
Practice Address - Fax:606-393-0147
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049077207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2907574Medicaid
MIOG06056OtherBCBS
MIE49680Medicare UPIN
MIOG06056003Medicare ID - Type Unspecified