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General NPI Number Information
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NPI Number | 1952065237
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Entity Type | Organization
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Legal Business Name | PATTERSON PHELBOTOMY LLC
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Dates
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Enumeration Date | 10/24/2021
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Last Update Date | 10/24/2021
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Provider Practice Location Address
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Address Line | 11809 CAROL AVE
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City | WARREN
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State | MI
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Zip | 48093-4619
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Country | US
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Telephone | 586-360-7179
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Fax |
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Provider Business Mailing Address
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Address Line | 37700 HARPER AVE # B3
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48036-3021
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Country | US
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Telephone | 586-360-7179
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Fax |
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Authorized Official
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Title or Position | MEMBER/DELEGATE
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Name | ROBERT A PATTERSON
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Credential | CPT,CMA,OWNER
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Telephone | 586-360-7179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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