Provider Demographics
NPI:1760652655
Name:PATSY, ANTHONY A JR (DO)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:A
Last Name:PATSY
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:818 W KING ST STE 101
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2117
Mailing Address - Country:US
Mailing Address - Phone:989-725-8171
Mailing Address - Fax:989-723-1257
Practice Address - Street 1:818 W KING ST STE 101
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2117
Practice Address - Country:US
Practice Address - Phone:989-725-8171
Practice Address - Fax:989-723-1257
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101017360207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1760652655Medicaid
MI1760652655Medicaid