Provider Demographics
NPI:1265411839
Name:ROBERT F PATTE DPM
Entity type:Organization
Organization Name:ROBERT F PATTE DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:PATTE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:815-455-3788
Mailing Address - Street 1:460 COVENTRY LANE
Mailing Address - Street 2:STE 103
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7561
Mailing Address - Country:US
Mailing Address - Phone:815-455-3788
Mailing Address - Fax:815-455-4657
Practice Address - Street 1:460 COVENTRY LANE
Practice Address - Street 2:STE 103
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7561
Practice Address - Country:US
Practice Address - Phone:815-455-3788
Practice Address - Fax:815-455-4657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0060101261OtherBCBS
IL0060101261OtherBCBS
ILT35498Medicare UPIN