Provider Demographics
NPI:1750630216
Name:MIGUEL BATLLE MD PA
Entity Type:Organization
Organization Name:MIGUEL BATLLE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BATLLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-215-8727
Mailing Address - Street 1:2233 PARK AVE
Mailing Address - Street 2:405
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5570
Mailing Address - Country:US
Mailing Address - Phone:904-215-8727
Mailing Address - Fax:904-215-7829
Practice Address - Street 1:2233 PARK AVE
Practice Address - Street 2:405
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5570
Practice Address - Country:US
Practice Address - Phone:904-215-8727
Practice Address - Fax:904-215-7829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069875174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty