=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184623209
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENNETH ROBERT PATTON DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2005
-----------------------------------------------------
Last Update Date | 07/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10500 MONTGOMERY RD
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45242-4402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-865-1307
-----------------------------------------------------
Fax | 513-865-1444
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1472 SOLUTIONS CTR
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60677-1044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-557-3333
-----------------------------------------------------
Fax | 513-557-3332
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | OS011029L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 07824
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------