Provider Demographics
NPI:1306411723
Name:SLATTERY, JOHN PATRICK III
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PATRICK
Last Name:SLATTERY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3168 GREENFIELD RD APT 5A
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6533
Mailing Address - Country:US
Mailing Address - Phone:978-793-0204
Mailing Address - Fax:
Practice Address - Street 1:11885 E 12 MILE RD STE 300A
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3467
Practice Address - Country:US
Practice Address - Phone:586-582-6630
Practice Address - Fax:586-582-6631
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program