Individual
PATRICK J. MCNELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1234 NAPIER AVE, SAINT JOSEPH, MI 49085-2112
(269) 985-4632
(269) 985-4623
Mailing address
6416 DEANS HILL RD, BERRIEN CENTER, MI 49102-9750
(269) 985-4632
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01059499A
IN
208M00000X
Hospitalist Physician
036-055852
IL
208M00000X
Hospitalist Physician
Primary
4301101997
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000743297
BCBS
IN
05
—
036055852
—
IL
05
—
200989440
—
IN
Enumeration date
08/30/2006
Last updated
11/20/2012
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