Provider Demographics
NPI:1265535272
Name:PHILLIPS, TAMMY (MD)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W SAGINAW RD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48657-9206
Mailing Address - Country:US
Mailing Address - Phone:989-687-9400
Mailing Address - Fax:989-687-9945
Practice Address - Street 1:40 W SAGINAW RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:MI
Practice Address - Zip Code:48657-9206
Practice Address - Country:US
Practice Address - Phone:989-687-9400
Practice Address - Fax:989-687-9945
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITP053327207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE87901Medicare UPIN
MIM43020010Medicare PIN