Individual
KENNETH PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
202 LAKE MIRIAM DR UNIT 1, LAKELAND, FL 33813-2180
(866) 400-3376
(863) 709-0273
Mailing address
151 SOUTHHALL LN STE 300, MAITLAND, FL 32751-7172
(866) 400-3376
(407) 650-3455
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
A75725
CA
208200000X
Plastic Surgery Physician
Primary
ME176103
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A757250
—
CA
Enumeration date
11/01/2006
Last updated
06/09/2026
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