Provider Demographics
NPI:1639277429
Name:PATTON, DONALD G (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:G
Last Name:PATTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 E HAGERMAN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:IRON RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49935-7923
Mailing Address - Country:US
Mailing Address - Phone:906-265-3131
Mailing Address - Fax:
Practice Address - Street 1:1615 MAPLE LN
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-3610
Practice Address - Country:US
Practice Address - Phone:715-685-5500
Practice Address - Fax:715-682-4022
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31958207Q00000X
MI4301061515207Q00000X, 208D00000X
MIBP2711605207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN65B87PAOtherBLUE CROSS BLUE SHIELD
MI1639277429Medicaid
MI104142720Medicaid
WI31756100Medicaid
E87801Medicare UPIN
MN65B87PAOtherBLUE CROSS BLUE SHIELD
WI0004900250Medicare ID - Type Unspecified