Provider Demographics
NPI:1285646711
Name:BATHRICK, THOMAS PALMER (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PALMER
Last Name:BATHRICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 LINCOLN WAY E
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46613-3205
Mailing Address - Country:US
Mailing Address - Phone:574-234-0851
Mailing Address - Fax:574-234-7072
Practice Address - Street 1:1432 LINCOLN WAY E
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46613-3205
Practice Address - Country:US
Practice Address - Phone:574-234-0851
Practice Address - Fax:574-234-7072
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000736A207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100139490Medicaid
IN222130BMedicare PIN