Healthcare Provider Details

I. General information

NPI: 1881682821
Provider Name (Legal Business Name): DAVID G PATTERSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25620 GIBRALTAR RD
FLAT ROCK MI
48134-1243
US

IV. Provider business mailing address

25620 GIBRALTAR RD
FLAT ROCK MI
48134-1243
US

V. Phone/Fax

Practice location:
  • Phone: 734-789-9355
  • Fax: 734-789-1520
Mailing address:
  • Phone: 734-789-9355
  • Fax: 734-789-1520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101012588
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: