Individual
DR. STEPHEN RICHARD PHILLIPP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5001 US HIGHWAY 30 W STE D, FORT WAYNE, IN 46818-9701
(260) 432-1568
(260) 432-4969
Mailing address
PO BOX 80010, FORT WAYNE, IN 46898-0010
(260) 432-1568
(260) 432-4969
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01029911
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0591293
—
OH
05
—
100318850
—
IN
05
—
1386615565
—
MI
Enumeration date
01/27/2006
Last updated
06/17/2016
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