Phillips, Lisa

Phillips, Lisa is an individual health care provider with primary practice located at 320 E Armstrong Ave , Peoria IL 61603-3172. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Phillips, Lisa can be contacted via phone (309) 624-9690.

Contact Information

Primary practice address
320 E Armstrong Ave Peoria IL 61603-3172
Phone: (309) 624-9690
Fax: (309) 624-9723
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 036-067749 Illinois

Profile Details

NPI number 1720159577
LBN Legal business name Phillips, Lisa
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 13th, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720159577 NPPES
Illinois MEDICAID 036067749

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