Healthcare Provider Details

I. General information

NPI: 1043123771
Provider Name (Legal Business Name): PATRICK MCMICHAEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CONVENTION AVE
PHILADELPHIA PA
19104-4311
US

IV. Provider business mailing address

1014 BELMONT AVE
HADDON TOWNSHIP NJ
08108-3223
US

V. Phone/Fax

Practice location:
  • Phone: 267-250-2082
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License NumberRN681227
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: