Individual
DR. KENNETH P. PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7 BLANCHARD CIR, SUITE 201, WHEATON, IL 60189-2039
(630) 653-2300
Mailing address
7 BLANCHARD CIR, SUITE 201, WHEATON, IL 60189-2039
(630) 653-2300
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036062772
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02215643
BLUE CROSS BLUE SHIELD
IL
05
—
036062772
—
IL
01
—
CA2795
MEDICARE RAILROAD GROUP
IL
Enumeration date
03/17/2006
Last updated
08/02/2008
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