Provider Demographics
NPI:1770818056
Name:KORTHUIS, PATRICK CHRISTOPHER (IDMT)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:CHRISTOPHER
Last Name:KORTHUIS
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 MEDICAL SQUADRON
Mailing Address - Street 2:2400 EAST DR. BLDG 3650
Mailing Address - City:SCOTT AFB
Mailing Address - State:IL
Mailing Address - Zip Code:62225
Mailing Address - Country:US
Mailing Address - Phone:618-229-7221
Mailing Address - Fax:
Practice Address - Street 1:2400 EAST DR
Practice Address - Street 2:BLDG 3650 RM 135
Practice Address - City:SCOTT AFB
Practice Address - State:IL
Practice Address - Zip Code:62225-5408
Practice Address - Country:US
Practice Address - Phone:618-229-7221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians