Provider Demographics
NPI:1881682821
Name:PATTERSON, DAVID G (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:25620 GIBRALTAR RD
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:MI
Mailing Address - Zip Code:48134-1243
Mailing Address - Country:US
Mailing Address - Phone:734-789-9355
Mailing Address - Fax:734-789-1520
Practice Address - Street 1:25620 GIBRALTAR RD
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:MI
Practice Address - Zip Code:48134-1243
Practice Address - Country:US
Practice Address - Phone:734-789-9355
Practice Address - Fax:734-789-1520
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101012588207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3509590Medicaid
MI3509590Medicaid
MIOM73650Medicare ID - Type Unspecified