Provider Demographics
NPI:1952327876
Name:MARKOWITZ, PHILLIP H (DO)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:H
Last Name:MARKOWITZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 W DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1125
Mailing Address - Country:US
Mailing Address - Phone:847-692-5010
Mailing Address - Fax:847-318-2852
Practice Address - Street 1:1875 W DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1186
Practice Address - Country:US
Practice Address - Phone:847-692-5010
Practice Address - Fax:847-318-2852
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074864207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036074864Medicaid
ILE70599Medicare UPIN
IL940541Medicare ID - Type Unspecified