Provider Demographics
NPI:1124342761
Name:PATTEN, CAITLIN RENAE
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:RENAE
Last Name:PATTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CAITLIN
Other - Middle Name:RENAE
Other - Last Name:KERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:SURGICAL ONCOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-5020
Mailing Address - Fax:414-805-5771
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:SURGICAL ONCOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-5020
Practice Address - Fax:414-805-5771
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-00411208600000X
WI563532086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC2412Medicaid
NC1124342761Medicaid
NCNCO280BMedicare PIN
NC1124342761Medicaid