Organization
DR PHILLIPS MEDICAL WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARYAM PHILLIPS MD (OWNER)
(407) 900-0613
Entity
Organization
Contact information
Practice address
2915 LAKEVIEW DR STE 1001, FERN PARK, FL 32730-2009
(407) 900-0613
(407) 335-6945
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(407) 960-1465
(407) 335-6945
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NH873
FL MEDICARE
FL
Enumeration date
10/12/2017
Last updated
03/25/2021
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