Provider Demographics
NPI:1437324787
Name:D PATTERSON HAWKINS
Entity Type:Organization
Organization Name:D PATTERSON HAWKINS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:PATTERSON
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:269-208-9590
Mailing Address - Street 1:960 AGARD AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-4051
Mailing Address - Country:US
Mailing Address - Phone:269-927-3011
Mailing Address - Fax:
Practice Address - Street 1:960 AGARD AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-4051
Practice Address - Country:US
Practice Address - Phone:269-927-3011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202005084251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P02890Medicare PIN