Provider Demographics
NPI:1528261336
Name:PATRICE L. HAROLD, M.D.,PLC
Entity type:Organization
Organization Name:PATRICE L. HAROLD, M.D.,PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAROLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-354-2201
Mailing Address - Street 1:29255 NORTHWESTERN HWY STE 301
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-5742
Mailing Address - Country:US
Mailing Address - Phone:248-354-2201
Mailing Address - Fax:248-354-2220
Practice Address - Street 1:29255 NORTHWESTERN HWY STE 301
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-5742
Practice Address - Country:US
Practice Address - Phone:248-354-2201
Practice Address - Fax:248-354-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4197245Medicaid
MIF68743Medicare UPIN
MI4197245Medicaid