Provider Demographics
NPI:1912902313
Name:PARK, PATRICK YOUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:YOUNG
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13421 OLD MERIDIAN ST
Mailing Address - Street 2:STE 210
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1411
Mailing Address - Country:US
Mailing Address - Phone:317-844-5273
Mailing Address - Fax:317-844-5709
Practice Address - Street 1:13421 OLD MERIDIAN ST
Practice Address - Street 2:STE 210
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1411
Practice Address - Country:US
Practice Address - Phone:317-844-5273
Practice Address - Fax:317-844-5709
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050716A208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN314500CMedicare ID - Type Unspecified
ING94691Medicare UPIN