MEDICARE: DR. KENNETH JAMES PATT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036036139	IL

General Provider Information

NPI Number	:	1386781763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH JAMES PATT MD

Provider Business Mailing Address
First Line	:	510 VINE AVE
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-4148
Country	:	US
Telephone Number	:	847-825-1409
Fax Number	:

Provider Business Practice Location Address
First Line	:	4759 N KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-4420
Country	:	US
Telephone Number	:	773-588-9640
Fax Number	:	773-588-9279

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/08/2007

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