Healthcare Provider Details

I. General information

NPI: 1184623209
Provider Name (Legal Business Name): KENNETH ROBERT PATTON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 MONTGOMERY RD
CINCINNATI OH
45242-4402
US

IV. Provider business mailing address

1472 SOLUTIONS CTR
CHICAGO IL
60677-1044
US

V. Phone/Fax

Practice location:
  • Phone: 513-865-1307
  • Fax: 513-865-1444
Mailing address:
  • Phone: 513-557-3333
  • Fax: 513-557-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS011029L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number07824
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: