Provider Demographics
NPI:1831213768
Name:PATTON, MICHAEL JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:PATTON
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 1:825 OAK GROVE AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4434
Mailing Address - Country:US
Mailing Address - Phone:650-323-9171
Mailing Address - Fax:
Practice Address - Street 1:825 OAK GROVE AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4434
Practice Address - Country:US
Practice Address - Phone:650-323-9171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC-32437174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA34932Medicare UPIN