Provider Demographics
NPI:1023139805
Name:PHILLIPS, JOSHUA D (MD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:D
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:N1025 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-4235
Mailing Address - Country:US
Mailing Address - Phone:262-374-7404
Mailing Address - Fax:262-248-1120
Practice Address - Street 1:21425 SPRING ST
Practice Address - Street 2:
Practice Address - City:UNION GROVE
Practice Address - State:WI
Practice Address - Zip Code:53182-9707
Practice Address - Country:US
Practice Address - Phone:262-878-2411
Practice Address - Fax:262-878-2922
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI53047-20207Q00000X
WI53047-0202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine