Provider Demographics
NPI:1609089317
Name:IMMESOETE, PHILLIP ARTHUR II (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ARTHUR
Last Name:IMMESOETE
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:770 W HIGH ST STE 160
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-5900
Mailing Address - Country:US
Mailing Address - Phone:419-995-4960
Mailing Address - Fax:
Practice Address - Street 1:770 W HIGH ST STE 160
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-5900
Practice Address - Country:US
Practice Address - Phone:419-995-4960
Practice Address - Fax:419-995-4961
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.090300207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery