Provider Demographics
NPI:1093383598
Name:PATTERSON, ROBERT ARNESS
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ARNESS
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:BOB
Other - Middle Name:ARNESSS
Other - Last Name:PATTERSON
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:BOARD CERTIFIED CMA,
Mailing Address - Street 1:37700 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3021
Mailing Address - Country:US
Mailing Address - Phone:586-360-7179
Mailing Address - Fax:
Practice Address - Street 1:11809 CAROL AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-4619
Practice Address - Country:US
Practice Address - Phone:313-955-7069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-12
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA21-7102174400000X
MI21-7102174400000X
DC21-7102374700000X
DC23117173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialist
No374700000XNursing Service Related ProvidersTechnician