Provider Demographics
NPI:1720297294
Name:PHILIPPE, MARC TODD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:TODD
Last Name:PHILIPPE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1500 JAMES SIMPSON JR WAY
Mailing Address - Street 2:STE 201
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-0801
Mailing Address - Country:US
Mailing Address - Phone:859-655-4111
Mailing Address - Fax:859-655-4815
Practice Address - Street 1:1500 JAMES SIMPSON JR WAY
Practice Address - Street 2:STE 201
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-0801
Practice Address - Country:US
Practice Address - Phone:859-655-4111
Practice Address - Fax:859-655-4815
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2021-12-15
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Provider Licenses
StateLicense IDTaxonomies
KY40853207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2775822Medicaid
KY7100014640Medicaid
KY7100014640Medicaid
KY0364980Medicare PIN