Provider Demographics
NPI:1104118355
Name:PHILLIPS, KELLY M (DVM)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:M
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 S RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5925
Mailing Address - Country:US
Mailing Address - Phone:847-854-3351
Mailing Address - Fax:
Practice Address - Street 1:1808 S RANDALL RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5925
Practice Address - Country:US
Practice Address - Phone:847-854-3351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL090010516174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian