Individual
MR. MICHAEL KENNETH PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
623 PUSAN DR, OCEANSIDE, CA 92058-8149
(847) 912-8212
Mailing address
623 PUSAN DR, OCEANSIDE, CA 92058-8149
(847) 912-8212
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
09/17/2012
Last updated
05/01/2013
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