Provider Demographics
NPI:1649614470
Name:PATNUGOT, KRISTOPHER JON-AMOR (DO)
Entity type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:JON-AMOR
Last Name:PATNUGOT
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 1:1223 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3221
Mailing Address - Country:US
Mailing Address - Phone:248-439-1060
Mailing Address - Fax:
Practice Address - Street 1:1223 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3221
Practice Address - Country:US
Practice Address - Phone:248-439-1060
Practice Address - Fax:248-394-1063
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020290207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine