Organization
MICHAEL JAY PHILLIPS, MD, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL JAY PHILLIPS MD (OWNER)
(262) 523-1245
Entity
Organization
Contact information
Practice address
1239 CORPORATE CENTER DR, OCONOMOWOC, WI 53066-4898
(262) 569-8346
Mailing address
1239 CORPORATE CENTER DR, OCONOMOWOC, WI 53066-4898
(262) 569-8346
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21295800
—
WI
Enumeration date
02/02/2006
Last updated
02/27/2013
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