Provider Demographics
NPI:1184626244
Name:ELLISON, PATRICK K (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:K
Last Name:ELLISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 636961
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6961
Mailing Address - Country:US
Mailing Address - Phone:270-538-6200
Mailing Address - Fax:270-538-6220
Practice Address - Street 1:1532 LONE OAK RD
Practice Address - Street 2:SUITE 310
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7913
Practice Address - Country:US
Practice Address - Phone:270-538-6200
Practice Address - Fax:270-538-6220
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY36887208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64040900Medicaid
KY64040900Medicaid
KYH12501Medicare UPIN