Provider Demographics
NPI:1184623209
Name:PATTON, KENNETH ROBERT (DO)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:ROBERT
Last Name:PATTON
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 1:1472 SOLUTIONS CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1044
Mailing Address - Country:US
Mailing Address - Phone:513-557-3333
Mailing Address - Fax:513-557-3332
Practice Address - Street 1:10500 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4402
Practice Address - Country:US
Practice Address - Phone:513-865-1307
Practice Address - Fax:513-865-1444
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS011029L207P00000X
OH07824207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2246653Medicaid
PA930121722OtherRR MEDICARE
NY00026217401OtherUNIVERA
IN200905480Medicaid
PA115099OtherUNISON
PA423269OtherBLUE SHIELD
KY7100044510Medicaid
PA217534OtherUPMC
OH2246653OtherOH MEDICAL ASSISTANCE
PA1512799OtherGATEWAY
PA2899000OtherAETNA
NY01959219OtherNY MEDICAL ASSISTANCE
PA0018387030006Medicaid
WV1068797OtherWEST VIRGINIA WORK COMP
PA0018387030006Medicaid
NY00026217401OtherUNIVERA
IN200905480Medicaid
OHP00663804Medicare PIN