Provider Demographics
NPI:1790258200
Name:PATTOCK, ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:PATTOCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5333 MCAULEY DR RM 2009
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1095
Mailing Address - Country:US
Mailing Address - Phone:734-712-0077
Mailing Address - Fax:734-712-0088
Practice Address - Street 1:5333 MCAULEY DR RM 2009
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1095
Practice Address - Country:US
Practice Address - Phone:734-712-0077
Practice Address - Fax:734-712-0088
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008878208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation