Individual
PHILLIP L WHITFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
186 E SOUTHWAY BLVD, KOKOMO, IN 46902-3650
(765) 236-8299
Mailing address
10330 N MERIDIAN ST # 300, INDIANAPOLIS, IN 46290-1024
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01026402A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000183509
ANTHEM
—
05
—
100069950A
—
IN
01
—
10787148
CAQH
—
Enumeration date
11/07/2005
Last updated
09/23/2016
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