Provider Demographics
NPI:1689630089
Name:HAROLD, PATRICE L (MD)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:L
Last Name:HAROLD
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 1:29255 NORTHWESTERN HWY STE 301
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-5742
Mailing Address - Country:US
Mailing Address - Phone:248-354-2201
Mailing Address - Fax:248-354-2220
Practice Address - Street 1:29255 NORTHWESTERN HWY STE 301
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034
Practice Address - Country:US
Practice Address - Phone:248-354-2201
Practice Address - Fax:248-354-2220
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPH054677207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION10610Medicare ID - Type Unspecified
MIN10610001Medicare PIN
F68743Medicare UPIN