Basic Information
Provider Information
NPI: 1033557384
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATTERSON
FirstName: KRISTEN
MiddleName: LYNNE
NamePrefix:  
NameSuffix:  
Credential: D.P.M
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 42550 GARFIELD RD
Address2: STE 103
City: CLINTON TOWNSHIP
State: MI
PostalCode: 480381644
CountryCode: US
TelephoneNumber: 3138080559
FaxNumber:  
Practice Location
Address1: 2900 N LAKE SHORE DR
Address2:  
City: CHICAGO
State: IL
PostalCode: 606575640
CountryCode: US
TelephoneNumber: 3122433769
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/10/2013
LastUpdateDate: 07/25/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
213ES0103X5315074411MIY Podiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery

No ID Information.


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