Phillips, Misty M.

Phillips, Misty M. is an individual health care provider with primary practice located at 2532 Farragut Dr , Springfield IL 62704-1433. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Phillips, Misty M. can be contacted via phone (217) 528-7541.

Contact Information

Primary practice address
2532 Farragut Dr Springfield IL 62704-1433
Phone: (217) 528-7541
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 036117503 Illinois

Profile Details

NPI number 1053461657
LBN Legal business name Phillips, Misty M.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 12th, 2007
Last updated May 21st, 2020 - about 6 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 1053461657 NPPES
Illinois MEDICAID 036117503

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