MEDICARE: DR. MICHAEL DAVID PATTERSON 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	207RN0300X	Nephrology Physician	34006927P	OH
2	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	34.006927	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	KI9260531	OTHER	OH	GROUP MEDICARE

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891792248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL DAVID PATTERSON D.O.

Provider Business Mailing Address
First Line	:	661 S TRIMBLE RD
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44906-3437
Country	:	US
Telephone Number	:	419-774-0478
Fax Number	:	419-774-9887

Provider Business Practice Location Address
First Line	:	800 MCCONNELL RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3463
Country	:	US
Telephone Number	:	614-566-5377
Fax Number	:	614-533-6200

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	12/22/2023

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