Provider Demographics
NPI:1891964185
Name:PATRICK MUNSON MDPC
Entity Type:Organization
Organization Name:PATRICK MUNSON MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:B
Authorized Official - Last Name:MUNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-424-0981
Mailing Address - Street 1:3141 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-1103
Mailing Address - Country:US
Mailing Address - Phone:734-424-0981
Mailing Address - Fax:734-424-0983
Practice Address - Street 1:3141 BAKER RD
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-1103
Practice Address - Country:US
Practice Address - Phone:734-424-0981
Practice Address - Fax:734-424-0983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045466207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0108101851OtherBLUE CROSS BLUE SHIELD
MI0108101851OtherBLUE CROSS BLUE SHIELD