Provider Demographics
NPI:1124077490
Name:PHILLIPS, MICHAEL S (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10 ENTERPRISE BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615
Mailing Address - Country:US
Mailing Address - Phone:864-254-6070
Mailing Address - Fax:864-254-6182
Practice Address - Street 1:10 ENTERPRISE BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6301
Practice Address - Country:US
Practice Address - Phone:864-254-6070
Practice Address - Fax:864-254-6182
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2020-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC12544207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC125448Medicaid
SCC46958Medicare UPIN
SC125448Medicaid
SCC469588802Medicare PIN
SCC469587951Medicare PIN