Provider Demographics
NPI:1750389771
Name:ENDERS, PATRICK DANIEL (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:DANIEL
Last Name:ENDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6009 LANDERHAVEN DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4192
Mailing Address - Country:US
Mailing Address - Phone:440-461-0042
Mailing Address - Fax:440-461-5033
Practice Address - Street 1:6009 LANDERHAVEN DR
Practice Address - Street 2:SUITE F
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-4192
Practice Address - Country:US
Practice Address - Phone:440-461-0042
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0399532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH31-1685729026OtherCARE SOURCE (MEDICAID)
OH31168572900OtherBUREAU OF WORKERS COMP
000000122911OtherANTHEM BC/BS (FACET#)
OH0321842Medicaid
OH311685729001OtherMEDICAL MUTUAL OF OH
OH311685729001OtherMEDICAL MUTUAL OF OH
OH31-1685729026OtherCARE SOURCE (MEDICAID)