Basic Information
| Provider Information | |||||||||
| NPI: | 1184623209 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATTON | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1472 SOLUTIONS CTR | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606771044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135573333 | ||||||||
| FaxNumber: | 5135573332 | ||||||||
| Practice Location | |||||||||
| Address1: | 10500 MONTGOMERY RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452424402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138651307 | ||||||||
| FaxNumber: | 5138651444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2005 | ||||||||
| LastUpdateDate: | 07/03/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | OS011029L | PA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 07824 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2246653 | 05 | OH | MEDICAID | 930121722 | 01 | PA | RR MEDICARE | OTHER | 00026217401 | 01 | NY | UNIVERA | OTHER | 200905480 | 05 | IN | MEDICAID | 115099 | 01 | PA | UNISON | OTHER | 423269 | 01 | PA | BLUE SHIELD | OTHER | 7100044510 | 05 | KY | MEDICAID | 217534 | 01 | PA | UPMC | OTHER | 2246653 | 01 | OH | OH MEDICAL ASSISTANCE | OTHER | 1512799 | 01 | PA | GATEWAY | OTHER | 2899000 | 01 | PA | AETNA | OTHER | 01959219 | 01 | NY | NY MEDICAL ASSISTANCE | OTHER | 0018387030006 | 05 | PA | MEDICAID | 1068797 | 01 | WV | WEST VIRGINIA WORK COMP | OTHER |