Provider Demographics
NPI:1760594899
Name:PATRIAS, REBECCA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LYNN
Last Name:PATRIAS
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 1:755 DARWIN DR
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1155
Mailing Address - Country:US
Mailing Address - Phone:734-433-1500
Mailing Address - Fax:734-433-1400
Practice Address - Street 1:350 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1280
Practice Address - Country:US
Practice Address - Phone:734-433-1500
Practice Address - Fax:734-433-1400
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049128207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID83118Medicare UPIN