Individual
MICHAEL R PATRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AA-C
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-7330
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
67-000118
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000232299
UNISON
OH
01
—
000000515971
ANTHEM
OH
01
—
0583328
BCMH
OH
05
—
2739219
—
OH
01
—
415019
WELLCARE MEDICAID
OH
01
—
7819952
AETNA
OH
01
—
P00802872
MEDICARE RAILROAD
OH
Enumeration date
07/26/2006
Last updated
06/04/2013
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