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Individual

MATTHEW PHILLIPS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
8177 CLEARVISTA PKWY, INDIANAPOLIS, IN 46256-1662
(317) 621-7801
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01036001A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000313280
ANTHEM
IN
05
100066680
IN
01
P00259720
RR MEDICARE
IN
01
P01090296
RR MEDICARE PTAN
IN
Enumeration date
06/03/2006
Last updated
11/27/2023
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