Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 207R00000X | MI |
NPI | 1336131606 |
---|---|
Provider Name | Dr. Theodore N Batzer |
First Address | Manistee, MI 49660-9352 |
Second Address | Manistee, MI 49660-9352 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1099975 | (05) | MI |
1105101831 | BCBSM (01) | MI |
E40184 | (02) | MI |