Provider Demographics
NPI:1336131606
Name:BATZER, THEODORE N (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:N
Last Name:BATZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1391 E PARKDALE AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-9352
Mailing Address - Country:US
Mailing Address - Phone:231-398-1800
Mailing Address - Fax:231-398-1802
Practice Address - Street 1:1391 E PARKDALE AVE
Practice Address - Street 2:STE 102
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-9352
Practice Address - Country:US
Practice Address - Phone:231-398-1800
Practice Address - Fax:231-398-1802
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207R00000X204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1105101831OtherBCBSM
MI1099975Medicaid
MI1105101831OtherBCBSM