Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 11931 | AZ |
NPI | 1003965492 |
---|---|
Provider Name | Mr. Kenneth Alan Batko |
First Address | Sun City, AZ 85351 |
Second Address | Sun City, AZ 85351-3059 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
234162 | (05) | AZ |
C99103 | (02) |