Individual
DR. MARTIN T PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
555 W COURT ST, SUITE 108, KANKAKEE, IL 60901-3664
(888) 220-6432
(630) 654-4253
Mailing address
901 MCCLINTOCK DR, SUITE 202, BURR RIDGE, IL 60527-0844
(888) 220-6432
(630) 654-4253
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
036-104648
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-104-648
—
IL
05
—
0420307
—
IA
Enumeration date
09/22/2005
Last updated
12/29/2021
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