Individual
BRYAN J PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
718 S WEBER ROAD, BOLINGBROOK, IL 60490
(630) 378-4799
(630) 378-4783
Mailing address
718 S WEBER ROAD, BOLINGBROOK, IL 60490
(630) 378-4799
(630) 378-4783
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036098037
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0031600193
BLUE SHIELD
IL
05
—
036098037
—
IL
01
—
180039547
RAILROAD MEDICARE
IL
01
—
3970320001
DMERC
IL
01
—
K46495
MEDICARE PROVIDER NUMBER
IL
Enumeration date
06/22/2005
Last updated
07/26/2013
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