Healthcare Provider Details

I. General information

NPI: 1467591792
Provider Name (Legal Business Name): MICHAEL PATIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6417 BAY PKWY
BROOKLYN NY
11204-3930
US

IV. Provider business mailing address

239 CORBIN PL
BROOKLYN NY
11235-4901
US

V. Phone/Fax

Practice location:
  • Phone: 718-234-6767
  • Fax: 718-234-0994
Mailing address:
  • Phone: 718-743-6607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number199927
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: