Provider Demographics
NPI:1437135134
Name:PHILLIPS, ERIC A (DO)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:A
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4967 CROOKS RD
Mailing Address - Street 2:STE 130
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-5801
Mailing Address - Country:US
Mailing Address - Phone:248-952-1601
Mailing Address - Fax:248-952-1614
Practice Address - Street 1:2800 BALTANE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-3100
Practice Address - Country:US
Practice Address - Phone:734-464-0887
Practice Address - Fax:734-402-0254
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101007871207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1437135134Medicaid
MI5630465OtherBCBS INDIVIDUAL
MI507906OtherCARE-PREFERRED CHOICES
MI700H219150OtherBLUE SHIELD
MI1437135134Medicaid
MI0N47600003Medicare PIN