Provider Demographics
NPI:1952065237
Name:PATTERSON PHELBOTOMY LLC
Entity Type:Organization
Organization Name:PATTERSON PHELBOTOMY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/DELEGATE
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPT,CMA,OWNER
Authorized Official - Phone:586-360-7179
Mailing Address - Street 1:37700 HARPER AVE # B3
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3021
Mailing Address - Country:US
Mailing Address - Phone:586-360-7179
Mailing Address - Fax:
Practice Address - Street 1:11809 CAROL AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-4619
Practice Address - Country:US
Practice Address - Phone:586-360-7179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-24
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty