Provider Demographics
NPI:1003965492
Name:BATKO, KENNETH ALAN (MD)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:ALAN
Last Name:BATKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10615 W THUNDERBIRD BLVD
Mailing Address - Street 2:B300
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351
Mailing Address - Country:US
Mailing Address - Phone:623-933-0176
Mailing Address - Fax:623-933-2808
Practice Address - Street 1:10615 W THUNDERBIRD BLVD
Practice Address - Street 2:B300
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3059
Practice Address - Country:US
Practice Address - Phone:623-933-0176
Practice Address - Fax:623-933-2808
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11931207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ234162Medicaid
C99103Medicare UPIN
AZ234162Medicaid