Individual
PHILLIP A ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
630 BROADWAY ST # 2, MADISON, IN 47250-3310
(812) 801-0995
(812) 801-8621
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01039654
IN
208D00000X
General Practice Physician
01039654
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100103060A
—
IN
05
—
64873219
—
KY
Enumeration date
07/05/2006
Last updated
10/13/2025
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