Provider Demographics
NPI:1891792248
Name:PATTERSON, MICHAEL DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 S TRIMBLE RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-3437
Mailing Address - Country:US
Mailing Address - Phone:419-774-0478
Mailing Address - Fax:419-774-9887
Practice Address - Street 1:800 MCCONNELL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3463
Practice Address - Country:US
Practice Address - Phone:614-566-5377
Practice Address - Fax:614-533-6200
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006927P207RN0300X
OH34.006927207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2321697Medicaid
OHKI9260531OtherGROUP MEDICARE
OH0114549OtherGROUP MEDICAID
OH0114549OtherGROUP MEDICAID
OHKI9260531OtherGROUP MEDICARE