Basic Information
| Provider Information | |||||||||
| NPI: | 1619590197 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORAN | ||||||||
| FirstName: | PATRICK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1522 SIMPSON DRIVE | ||||||||
| Address2: | MPB D3230 | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347635589 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 E EISENHOWER PKWY STE B | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481083302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342322600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2020 | ||||||||
| LastUpdateDate: | 05/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 4351045892 | MI | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.