Provider Demographics
NPI:1356871016
Name:DIFFERDING, PATRICK MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:MICHAEL
Last Name:DIFFERDING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:20508 HELLENIC DR
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1424
Mailing Address - Country:US
Mailing Address - Phone:708-209-8931
Mailing Address - Fax:
Practice Address - Street 1:1300 N HIGHLAND AVE STE 1
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1481
Practice Address - Country:US
Practice Address - Phone:630-897-5104
Practice Address - Fax:630-897-5089
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036.158568207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program