Provider Demographics
NPI:1225167513
Name:MEDINA-MCDEVITT, PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MEDINA-MCDEVITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:MEDINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:929 RIDGE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-1751
Mailing Address - Country:US
Mailing Address - Phone:219-836-0606
Mailing Address - Fax:219-322-0084
Practice Address - Street 1:929 RIDGE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1751
Practice Address - Country:US
Practice Address - Phone:219-836-0606
Practice Address - Fax:219-322-0084
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034581A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology