Provider Demographics
NPI:1477582955
Name:PATRUS, ROBERT
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:PATRUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26020 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3773
Mailing Address - Country:US
Mailing Address - Phone:586-775-1910
Mailing Address - Fax:586-775-8387
Practice Address - Street 1:26020 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-3773
Practice Address - Country:US
Practice Address - Phone:586-775-1910
Practice Address - Fax:586-775-8387
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRP001617213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2920950Medicaid
MI485505061OtherBLUE CROSS BLUE SHIELD
MI2920950Medicaid