Provider Demographics
NPI:1922278795
Name:ROBERT M. PHILLIPS JR M.D. P.C.
Entity Type:Organization
Organization Name:ROBERT M. PHILLIPS JR M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:248-334-9542
Mailing Address - Street 1:35 S JOHNSON ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1658
Mailing Address - Country:US
Mailing Address - Phone:248-334-9542
Mailing Address - Fax:248-334-6792
Practice Address - Street 1:35 S JOHNSON ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1658
Practice Address - Country:US
Practice Address - Phone:248-334-9542
Practice Address - Fax:248-334-6792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0636895OtherBLUE CROSS BLUE SHIELD
MI0M34390Medicare PIN
MI0636895OtherBLUE CROSS BLUE SHIELD