DR. CAMERON PATTHANACHAROENPHON (NPI# 1073834339) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073834339 |
| Entity Type | Individual |
| Full Name | DR. CAMERON PATTHANACHAROENPHON |
| Credential | M.D. |
| Practice Address |
350 Lafayette Ave Se 4th Floor Grand Rapids MI 49503-4656 |
| Mailing Address |
3565 Momentum Pl Chicago IL 60689-5335 |
| Practice Telephone | 6164568515 |
| Practice Fax Number | 6164568208 |
| Mailing Telephone | 6164568515 |
| Mailing Fax Number | 6164568208 |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2017-09-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207XX0004X |
Orthopaedic Surgery Specialization: Foot and Ankle Surgery |
4301096531 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 1073834339 | 05 |
| Street Address |
350 LAFAYETTE AVE SE 4TH FLOOR |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49503-4656 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760481782 | Geoffrey A Sandman | Orthopaedic Surgery | 350 Lafayette Ave Se, 4th Floor, Grand Rapids, MI 49503-4656 | 2005-07-20 |
| 1497205140 | Lauren Elizabeth Tweedy | Occupational Therapist | 350 Lafayette Ave Se, Grand Rapids, MI 49503-4656 | 2016-10-06 |
| 1275903163 | Jennifer Herrick | Specialist/Technologist | 350 Lafayette Ave Se, Grand Rapids, MI 49503-4656 | 2015-10-05 |
| 1134514490 | Kevin Vandokkumburg | Physician Assistant | 350 Lafayette Ave Se, 4th Floor, Grand Rapids, MI 49503-4656 | 2015-04-03 |
| 1982098356 | Amber Wilson | Specialist/Technologist | 350 Lafayette Ave Se, Grand Rapids, MI 49503-4656 | 2015-03-24 |
| 1356730048 | Gretchen Shay Goodman | Specialist/Technologist | 350 Lafayette Ave Se, Grand Rapids, MI 49503-4656 | 2015-01-18 |
| 1417380544 | Clayton J Jewell | Occupational Therapist | 350 Lafayette Ave Se, Grand Rapids, MI 49503-4656 | 2013-08-13 |
| 1437402542 | Mary Free Bed Hospital and Rehabiliation Center | Physical Therapist | 350 Lafayette Ave Se, Grand Rapids, MI 49503-4656 | 2012-10-26 |
| 1689927873 | Clarence J Verbrugge | Physical Therapist | 350 Lafayette Ave Se, Grand Rapids, MI 49503-4656 | 2012-10-25 |
| 1083972244 | Laura Miersen | Physical Therapist | 350 Lafayette Ave Se, Suite 500, Grand Rapids, MI 49503-4656 | 2012-04-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801496195 | Airway Oxygen, Inc. | Durable Medical Equipment & Medical Supplies | Lemmen Holton Cancer Pavilion, 145 Michigan St Ne Ste 3400, Grand Rapids, MI 49503 | 2020-10-27 |
| 1730707282 | Adriana Molina-schmuker | Counselor | 901 Eastern Avenue Ne, Grand Rapids, MI 49503 | 2020-07-10 |
| 1477176949 | Kimberly Buskirk | Specialist | 1131 Ionia Ava Nw, Grand Rapids, MI 49503 | 2020-05-19 |
| 1124647805 | Jared Host | Speech-Language Pathologist | Mercy Health Hauenstein Neuroscience Center 220 Cherry, Grand Rapids, MI 49503 | 2020-04-13 |
| 1265061378 | Heather Gladfelter | Student in an Organized Health Care Education/Training Program | 339 Barclay Ave Ne Ste 300, Grand Rapids, MI 49503 | 2020-04-02 |
| 1194368647 | Amy Jo Arends | Nurse Practitioner | 350 Lafayette S.e., Suite 301, Grand Rapids, MI 49503 | 2019-10-28 |
| 1376185199 | Beth Arce | Occupational Therapist | 245 Cherry St Se Suite 302, Grand Rapids, MI 49503 | 2019-10-14 |
| 1295387256 | Althea Ziolkowski | Licensed Practical Nurse | Salvation Army Turning Point Programs, 1215 Fulton St E, Grand Rapids, MI 49503 | 2019-07-10 |
| 1790340719 | Heather Anne Fox | Occupational Therapist | Marywood, 111 Lakeside Dr Ne, Grand Rapids, MI 49503 | 2019-05-06 |
| 1184182883 | April L Kaiserlian | Social Worker | 983 Spaulding Ave Ne, Ada, MI 49503 | 2019-03-12 |
| Find all providers in zip 49503 | ||||
| Taxonomy Code | 207XX0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Foot and Ankle Surgery |
| Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, foot and ankle surgeons deal with adult reconstructive foot and ankle surgery, adult foot and ankle trauma, sports medicine foot and ankle, and children's foot and ankle reconstructive surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: title modified, definiton added, source added] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Separate board certification is not currently offered. ACGME Accredited Residency Program Requirements: 1 year of training with 5 years Orthopedic Surgery for a total of 6 years. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669422077 | John D Maskill | Orthopaedic Surgery | 1111 Leffingwell Ave Ne, Ste 100, Grand Rapids, MI 49525 | 2006-05-10 |
| 1700874294 | John G Anderson | Orthopaedic Surgery | 1111 Leffingwell Ave Ne, Ste 100, Grand Rapids, MI 49525 | 2005-10-10 |
| 1659370666 | Patricia Kolodziej | Orthopaedic Surgery | 350 Lafayette Ave Se, 4th Floor, Grand Rapids, MI 49503-4656 | 2005-07-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215999339 | Christopher N Zingas | Orthopaedic Surgery | 23829 Little Mack Ave, Suite 100, Saint Clair Shores, MI 48080-1186 | 2006-04-04 |
| 1952822132 | Damian Joseph Hilbert | Orthopaedic Surgery | 33155 Annapolis St, Wayne, MI 48184-2405 | 2017-06-28 |
| 1902218191 | Michael Swords, Do, Pllc | Orthopaedic Surgery | 2815 S Pennsylvania Ave, Suite 204, Lansing, MI 48910-3495 | 2014-05-22 |
| 1861752768 | Sean A. Matuszak Md PC | Orthopaedic Surgery | 1350 Kirts Blvd, Suite 160, Troy, MI 48084-4851 | 2012-05-24 |
| 1437374931 | Andrew Moore | Orthopaedic Surgery | 14650 E. Old Us Hwy 12, Suite 105, Chelsea, MI 48118 | 2007-04-17 |
| 1740382183 | Sjmh Medical Practice | Orthopaedic Surgery | 44555 Woodward Ave, Suite 105, Pontiac, MI 48341-5031 | 2006-09-05 |
| 1942224894 | Norman J Licht | Orthopaedic Surgery | 4045 W Royal Dr, Traverse City, MI 49684-8965 | 2006-07-26 |
| 1972551836 | Robert M Mihalich | Orthopaedic Surgery | 2305 Genoa Business Park Dr, #170, Brighton, MI 48114-7004 | 2006-05-04 |
| 1942275490 | Michael P Swords | Orthopaedic Surgery | 2815 S Pennsylvania Ave, Suite 204, Lansing, MI 48910-3495 | 2006-02-20 |
| 1942208533 | Arthur Manoli II | Orthopaedic Surgery | 44555 Woodward Ave, Suite 105, Pontiac, MI 48341-5031 | 2005-07-08 |
| Find all providers with the same taxonomy | ||||
| City | GRAND RAPIDS |
| Zip Code | 49503 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.