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General NPI Number Information
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NPI Number | 1740791193
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Entity Type | Individual
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Provider Name | VICTORIA PATTERSON
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Gender | Female
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Dates
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Enumeration Date | 10/12/2017
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Last Update Date | 10/12/2017
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Provider Practice Location Address
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Address Line | 7521 MICHIGAN AVE
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City | DETROIT
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State | MI
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Zip | 48210-2229
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Country | US
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Telephone | 313-436-4661
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Fax |
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Provider Business Mailing Address
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Address Line | 4905 MADISON ST
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48125-2363
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Country | US
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Telephone | 313-412-5171
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 2701169133
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License Number State | MI
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