Provider Demographics
NPI:1588844302
Name:PATRICK D. ENDERS, M.D., L.L.C.
Entity Type:Organization
Organization Name:PATRICK D. ENDERS, M.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:ENDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-461-0042
Mailing Address - Street 1:6009 LANDERHAVEN DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4192
Mailing Address - Country:US
Mailing Address - Phone:440-461-0042
Mailing Address - Fax:440-461-5033
Practice Address - Street 1:6009 LANDERHAVEN DR
Practice Address - Street 2:SUITE F
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-4192
Practice Address - Country:US
Practice Address - Phone:440-461-0042
Practice Address - Fax:440-461-5033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350399532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0321842Medicaid
A75798OtherUPIN
000000122911OtherBLUE CROSS BLUE SHIELD
OH0321842Medicaid
000000122911OtherBLUE CROSS BLUE SHIELD
A75798OtherUPIN
A75798OtherUPIN