Provider Demographics
NPI:1831142488
Name:PATALINGHUG, OLIVER C (PT)
Entity Type:Individual
Prefix:MR
First Name:OLIVER
Middle Name:C
Last Name:PATALINGHUG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 W HAMLIN RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3835
Mailing Address - Country:US
Mailing Address - Phone:248-608-3149
Mailing Address - Fax:248-608-3149
Practice Address - Street 1:2370 WALTON BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1471
Practice Address - Country:US
Practice Address - Phone:248-608-3149
Practice Address - Fax:248-608-3149
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005647225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4670561Medicaid
MI65-0-F3-6075-0OtherBLUE CROSS BLUE SHIELD
MI141317OtherCARE CHOICES
MI562474213OtherPPOM
MI562474213OtherAETNA
MI024298OtherMIDWEST
MIQ08666Medicare UPIN
MI562474213OtherAETNA