Healthcare Provider Details

I. General information

NPI: 1770984577
Provider Name (Legal Business Name): JOSEPH CHARLES PATTERSON BS-IHS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 11/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W PATERSON ST
KALAMAZOO MI
49007-2557
US

IV. Provider business mailing address

117 W PATERSON ST
KALAMAZOO MI
49007-2557
US

V. Phone/Fax

Practice location:
  • Phone: 269-349-2641
  • Fax: 269-201-2855
Mailing address:
  • Phone: 269-349-2641
  • Fax: 269-201-2855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: