Provider Demographics
NPI:1871565549
Name:POCZATEK, PATTI S (MD)
Entity type:Individual
Prefix:DR
First Name:PATTI
Middle Name:S
Last Name:POCZATEK
Suffix:
Gender:F
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:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:VANCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41179-0550
Mailing Address - Country:US
Mailing Address - Phone:606-796-3029
Mailing Address - Fax:606-796-6221
Practice Address - Street 1:17521 W KY 9
Practice Address - Street 2:
Practice Address - City:TOLLESBORO
Practice Address - State:KY
Practice Address - Zip Code:41189-9711
Practice Address - Country:US
Practice Address - Phone:606-798-3151
Practice Address - Fax:606-798-2222
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64056070Medicaid
KYH72341Medicare UPIN
KY0055625Medicare PIN