Provider Demographics
NPI:1992761159
Name:PATRICIO, MANUEL FLORENT JULIAN (MD)
Entity type:Individual
Prefix:DR
First Name:MANUEL FLORENT
Middle Name:JULIAN
Last Name:PATRICIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:589 WILDBROOK LN
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45807-1991
Mailing Address - Country:US
Mailing Address - Phone:419-999-1060
Mailing Address - Fax:
Practice Address - Street 1:730 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4602
Practice Address - Country:US
Practice Address - Phone:419-226-9024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.068409207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000317857OtherANTHEM BCBS
OH0198674Medicaid
P00060423OtherRAILROAD MEDICARE
OHP00060425OtherMEDICARE RR
OHF 98137Medicare UPIN
OH0198674Medicaid