MEDICARE: PATRICK DANIEL ENDERS MD

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	35.039953	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	31168572900	OTHER	OH	BUREAU OF WORKERS COMP
3	000000122911	OTHER		ANTHEM BC/BS (FACET#)
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	311685729001	OTHER	OH	MEDICAL MUTUAL OF OH

General Provider Information

NPI Number	:	1750389771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK DANIEL ENDERS MD

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	:

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	07/08/2007

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