MEDICARE: DR. KRISTOPHER JON-AMOR PATNUGOT D.O.

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	207Q00000X	Family Medicine Physician	5101020290	MI

General Provider Information

NPI Number	:	1649614470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTOPHER JON-AMOR PATNUGOT D.O.

Provider Business Mailing Address
First Line	:	1223 S WASHINGTON AVE
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-3221
Country	:	US
Telephone Number	:	248-439-1060
Fax Number	:

Provider Business Practice Location Address
First Line	:	1223 S WASHINGTON AVE
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-3221
Country	:	US
Telephone Number	:	248-439-1060
Fax Number	:	248-394-1063

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2013
Last Update Date	:	10/08/2018

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