Provider Demographics
NPI:1215254990
Name:PATRICE DUQUETTE M.D.P.C.
Entity type:Organization
Organization Name:PATRICE DUQUETTE M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-594-7690
Mailing Address - Street 1:25328 HENLEY AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1707
Mailing Address - Country:US
Mailing Address - Phone:248-594-7690
Mailing Address - Fax:248-594-7663
Practice Address - Street 1:380 N OLD WOODWARD AVE
Practice Address - Street 2:SUITE 156
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-5347
Practice Address - Country:US
Practice Address - Phone:248-594-7690
Practice Address - Fax:248-594-7663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010549352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM17770Medicare PIN
MIF63476Medicare UPIN