Provider Demographics
NPI:1376804831
Name:PATRU, TIM (MD)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:PATRU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11206 QUARTERMASTER LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-3583
Mailing Address - Country:US
Mailing Address - Phone:423-328-2488
Mailing Address - Fax:916-251-0414
Practice Address - Street 1:8033 RAY MEARS BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5458
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:916-251-0414
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT201665207Q00000X
MI4301108701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine