Healthcare Provider Details

I. General information

NPI: 1952871261
Provider Name (Legal Business Name): KARL PATRICK SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2018
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17133 MENDOTA ST
DETROIT MI
48221-2306
US

IV. Provider business mailing address

17133 MENDOTA ST
DETROIT MI
48221-2306
US

V. Phone/Fax

Practice location:
  • Phone: 313-283-8494
  • Fax:
Mailing address:
  • Phone: 313-283-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License NumberAS820315246
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: