Individual
DONALD MICHAEL PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1356 S LAKE PARK AVE, HOBART, IN 46342-5964
(219) 942-8518
(219) 947-2751
Mailing address
1356 S LAKE PARK AVE, HOBART, IN 46342-5964
(219) 942-8518
(219) 947-2751
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01020846A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000086604
BLUE CROSS BLUE SHIELD
IN
05
—
100159850A
—
IN
Enumeration date
01/18/2006
Last updated
09/16/2015
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