Organization
MICHAEL J. PHILLIPS, M.D., S.C.
Active
Other names
Laboratory Pathology Services
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL J PHILLIPS M.D. (PRESIDENT)
(262) 569-0619
Entity
Organization
Contact information
Practice address
791 E SUMMIT AVE, OCONOMOWOC, WI 53066-3844
(262) 569-0619
(262) 569-0697
Mailing address
6400 INDUSTRIAL LOOP, GREENDALE, WI 53129-2452
(414) 423-4100
(414) 423-4134
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32778900
—
WI
Enumeration date
11/23/2005
Last updated
08/22/2020
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