Provider Demographics
NPI:1316388796
Name:BATISTA, JOSEFINA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEFINA
Middle Name:
Last Name:BATISTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 N WALL ST STE P310
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3484
Mailing Address - Country:US
Mailing Address - Phone:815-933-0194
Mailing Address - Fax:815-936-3847
Practice Address - Street 1:375 N WALL ST STE P310
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901
Practice Address - Country:US
Practice Address - Phone:815-933-0194
Practice Address - Fax:815-936-3847
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036144838208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036144838Medicaid