Provider Demographics
NPI:1427055268
Name:BEHRENS, PHILLIP HENRY (MD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:HENRY
Last Name:BEHRENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 SAINT MARYS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0521
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 SAINT MARYS DR STE 300
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0521
Practice Address - Country:US
Practice Address - Phone:812-473-2642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29312207RC0000X, 207RI0011X
IN01034969A207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
E06618Medicare UPIN
E06618Medicare UPIN
IN01034969AOtherIN LICENSE
INM400031557Medicare PIN
KYP400031327Medicare PIN
IN01034969AOtherIN LICENSE
IL036-085732OtherIL LICENSE
IN201002070BMedicaid