Individual
DR. KENNETH MICHAEL PATRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1024 LEMAY AVE, FT COLLINS, CO 80524-3913
(800) 553-4924
Mailing address
DEPT 2215, DENVER, CO 80291-0001
(800) 553-4924
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
44174
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123463300
—
WY
05
—
64435865
—
CO
01
—
P00394962
RAILROAD MEDICARE
CO
01
—
S5008
BCBS
CO
Enumeration date
06/07/2006
Last updated
02/24/2011
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