Provider Demographics
NPI:1568564813
Name:PATTERSON, MARIA JEVITZ (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:JEVITZ
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B545 WEST FEE HALL
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-1315
Mailing Address - Country:US
Mailing Address - Phone:517-353-3100
Mailing Address - Fax:
Practice Address - Street 1:1200 E MICHIGAN AVE STE 145
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1897
Practice Address - Country:US
Practice Address - Phone:517-364-5440
Practice Address - Fax:517-364-5409
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43014047752080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1844326Medicaid
MI3117740Medicaid
MIB43531Medicare UPIN
C36082125Medicare PIN
MI3117740Medicaid
MI0C36072011Medicare PIN