Provider Demographics
NPI:1477685790
Name:NOUD, PATRICK H (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:H
Last Name:NOUD
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 1:2815 S PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-3495
Mailing Address - Country:US
Mailing Address - Phone:517-267-0200
Mailing Address - Fax:517-267-1877
Practice Address - Street 1:2815 S PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3495
Practice Address - Country:US
Practice Address - Phone:517-267-0200
Practice Address - Fax:517-267-1877
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301095240207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2003300222OtherBLUE CARE NETWORK
MI9606154OtherAETNA
MI1055973OtherMCLAREN HEALTH PLAN-MEDICAID
MI200000021958OtherPHP
MI0M21440070OtherMEDICARE ADVANTAGE
MI1055973OtherMCLAREN HEALTH ADVANTAGE
MI2003300222OtherBLUE CROSS BLUE SHIELD
MI1055973OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI200000021958OtherPHP FAMILYCARE
MIM21440070Medicare PIN
MI0M21440070OtherMEDICARE ADVANTAGE