Healthcare Provider Details

I. General information

NPI: 1396356374
Provider Name (Legal Business Name): PATTERSONMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18851 NE 29TH AVE STE 700
AVENTURA FL
33180-2845
US

IV. Provider business mailing address

18121 NW 9TH AVE
MIAMI FL
33169-4215
US

V. Phone/Fax

Practice location:
  • Phone: 305-965-4997
  • Fax: 305-907-5669
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: ELTANYA A PATTERSON
Title or Position: OWNER
Credential: MD
Phone: 800-341-5096