MEDICARE: PATRICK D. ENDERS, M.D., L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	35039953	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	A75798	OTHER	UPIN
3	000000122911	OTHER	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1588844302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATRICK D. ENDERS, M.D., L.L.C.

Provider Business Mailing Address
First Line	:	6009 LANDERHAVEN DR
Second Line	:	SUITE F
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-4192
Country	:	US
Telephone Number	:	440-461-0042
Fax Number	:	440-461-5033

Provider Business Practice Location Address
First Line	:	6009 LANDERHAVEN DR
Second Line	:	SUITE F
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-4192
Country	:	US
Telephone Number	:	440-461-0042
Fax Number	:	440-461-5033

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PATRICK DANIEL ENDERS
Credential	:	M.D.
Telephone Number	:	440-461-0042

Provider Enumeration Date	:	11/08/2007
Last Update Date	:	04/20/2008

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