Provider Demographics
NPI:1902071962
Name:PHILLIP H MARKOWITZ, D.O., SC
Entity Type:Organization
Organization Name:PHILLIP H MARKOWITZ, D.O., SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:H
Authorized Official - Last Name:MARKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:847-692-5010
Mailing Address - Street 1:1875 DEMPSTER ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1186
Mailing Address - Country:US
Mailing Address - Phone:847-692-5010
Mailing Address - Fax:847-318-2852
Practice Address - Street 1:1875 DEMPSTER ST
Practice Address - Street 2:SUITE 150
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1186
Practice Address - Country:US
Practice Address - Phone:847-692-5010
Practice Address - Fax:847-318-2852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074864207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036074864Medicaid
IL940541Medicare PIN
E75099Medicare UPIN