Healthcare Provider Details

I. General information

NPI: 1619590197
Provider Name (Legal Business Name): PATRICK MORAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E EISENHOWER PKWY STE B
ANN ARBOR MI
48108-3302
US

IV. Provider business mailing address

1522 SIMPSON DRIVE MPB D3230
ANN ARBOR MI
48109
US

V. Phone/Fax

Practice location:
  • Phone: 734-232-2600
  • Fax:
Mailing address:
  • Phone: 734-763-5589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number87324-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: