Provider Demographics
NPI:1073331021
Name:PATRICK, BRIAN CECIL
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:CECIL
Last Name:PATRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 W FIKE RD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48657-9113
Mailing Address - Country:US
Mailing Address - Phone:989-430-5795
Mailing Address - Fax:
Practice Address - Street 1:616 E GILFORD RD
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723
Practice Address - Country:US
Practice Address - Phone:989-430-5795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist