Organization
JACQUELINE PHILLIPS DPM INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACQUELINE PHILLIPS DPM (PODIATRIST)
(313) 345-4449
Entity
Organization
Contact information
Practice address
5575 CONNER ST, SUITE 203, DETROIT, MI 48213-6400
(313) 345-4449
Mailing address
5575 CONNER ST, SUITE 203, DETROIT, MI 48213-6400
(313) 345-4449
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
5901001422
MI
332B00000X
Durable Medical Equipment & Medical Supplies
5901001422
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
134313228
—
MI
01
—
480H232340
BCBS PIN
MI
Enumeration date
07/02/2006
Last updated
12/09/2011
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