Individual
PATRICK E SOUTHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6913 N MAIN ST, GRANGER, IN 46530-8039
(574) 647-1550
(574) 243-4306
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 647-1825
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01042581A
IN
207Q00000X
Family Medicine Physician
01042581A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000782901
ANTHEM
IN
01
—
01042581A
INDIANA LICENSE
IN
01
—
01042581B
CSR
IN
05
—
100385740
—
IN
Enumeration date
07/19/2006
Last updated
06/20/2016
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