Provider Demographics
NPI:1821280223
Name:HUCK, PATRICK DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:DANIEL
Last Name:HUCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:36000 EUCLID AVE # MSO
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4625
Mailing Address - Country:US
Mailing Address - Phone:440-953-6082
Mailing Address - Fax:440-953-6101
Practice Address - Street 1:5105 SOM CENTER RD # 107
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4203
Practice Address - Country:US
Practice Address - Phone:440-953-5712
Practice Address - Fax:440-953-5713
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD442706208600000X
MDD0081496208600000X
VA0101259430208600000X
OH35.092448208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0189953Medicaid
PA103096616Medicaid
OHH506050OtherMEDICARE
OH0189953Medicaid