Individual
LISA PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
320 E ARMSTRONG AVE, PEORIA, IL 61603-3172
(309) 624-9690
(309) 624-9723
Mailing address
320 E ARMSTRONG AVE, PEORIA, IL 61603-3172
(309) 624-9690
(309) 624-9723
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036-067749
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036067749
—
IL
Enumeration date
11/13/2006
Last updated
07/08/2007
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