Provider Demographics
NPI:1043318181
Name:REBECCA L. PATRIAS, MD PLLC
Entity Type:Organization
Organization Name:REBECCA L. PATRIAS, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PATRIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-433-1500
Mailing Address - Street 1:350 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1280
Mailing Address - Country:US
Mailing Address - Phone:734-433-1500
Mailing Address - Fax:734-433-1400
Practice Address - Street 1:350 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1280
Practice Address - Country:US
Practice Address - Phone:734-433-1500
Practice Address - Fax:734-433-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049128207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherTAX ID