Provider Demographics
NPI:1851761746
Name:PATTERSON, DARSHAY
Entity Type:Individual
Prefix:
First Name:DARSHAY
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 W WARREN AVE APT 401
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48210-1474
Mailing Address - Country:US
Mailing Address - Phone:313-434-1317
Mailing Address - Fax:
Practice Address - Street 1:1101 W WARREN AVE APT 417
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-3616
Practice Address - Country:US
Practice Address - Phone:313-721-2189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIP 362 135 785 273171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications