Provider Demographics
NPI:1679574768
Name:PHILLIPS, ALEXANDER KONSTANTINE (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:KONSTANTINE
Last Name:PHILLIPS
Suffix:
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 1:15 SALT CREEK LANE
Mailing Address - Street 2:SUITE 119
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2962
Mailing Address - Country:US
Mailing Address - Phone:630-734-9560
Mailing Address - Fax:630-734-9565
Practice Address - Street 1:6801 W 34TH STREET
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3420
Practice Address - Country:US
Practice Address - Phone:708-484-0011
Practice Address - Fax:708-484-0549
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360665572085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036066557Medicaid
ILP09412Medicare PIN
ILK09575Medicare PIN
C39398Medicare UPIN
ILL94456Medicare PIN