Provider Demographics
NPI:1700014511
Name:GRESHAM, PATRICK CASEY (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:CASEY
Last Name:GRESHAM
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 1:19986 SUNBURY ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2028
Mailing Address - Country:US
Mailing Address - Phone:313-408-3006
Mailing Address - Fax:
Practice Address - Street 1:19986 SUNBURY ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2028
Practice Address - Country:US
Practice Address - Phone:313-408-3006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010949962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry