Individual
MATHEW TODD PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8620 BIGGIN HILL LN, LOUISVILLE, KY 40220-4117
(859) 817-3599
Mailing address
560 S LOOP RD, EDGEWOOD, KY 41017-3405
(859) 817-3599
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
036143518
IL
207X00000X
Orthopaedic Surgery Physician
35127665
OH
207X00000X
Orthopaedic Surgery Physician
Primary
43615
KY
207XS0117X
Orthopaedic Surgery of the Spine Physician
01067795A
IN
207XS0117X
Orthopaedic Surgery of the Spine Physician
43615
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000719168
ANTHEM
KY
05
—
036143518
—
IL
01
—
1840079
CIGNA
KY
01
—
201028740
MEDICAID INDIANA
KY
05
—
300071320
—
IN
01
—
50033377
PASSPORT ADVANTAGE
KY
05
—
7100123040
—
KY
01
—
9854581
AETNA
KY
01
—
P00966208
RR MEDICARE
KY
Enumeration date
06/18/2007
Last updated
04/05/2023
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