Individual
KENNETH J. PHILLIPS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3003 W GOOD HOPE RD, MILWAUKEE, WI 53209-2042
(414) 352-3100
(414) 247-4597
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
40558
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32492100
—
WI
01
—
P00470795
RR MEDICARE
WI
Enumeration date
07/10/2006
Last updated
12/10/2023
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