Healthcare Provider Details

I. General information

NPI: 1518318849
Provider Name (Legal Business Name): PAUL M PATEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST
DETROIT MI
48201-2196
US

IV. Provider business mailing address

3901 BEAUBIEN ST
DETROIT MI
48201-2196
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5437
  • Fax: 248-745-5260
Mailing address:
  • Phone: 313-745-5437
  • Fax: 248-551-2032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301110761
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number4301116865
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: