=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134410582
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIK ALLEN PATTISON M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2011
-----------------------------------------------------
Last Update Date | 10/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2451 INTELLIPLEX DR STE 260
-----------------------------------------------------
City | SHELBYVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46176-8580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-398-0121
-----------------------------------------------------
Fax | 317-398-0538
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 810
-----------------------------------------------------
City | HANOVER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03755-0810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-308-1472
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | EL11919
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | 01086587A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | 17726
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------