Provider Demographics
NPI:1821014929
Name:BATES, DONALD E (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:E
Last Name:BATES
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 1:500 EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-1821
Mailing Address - Country:US
Mailing Address - Phone:920-563-8280
Mailing Address - Fax:920-563-1494
Practice Address - Street 1:500 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-1821
Practice Address - Country:US
Practice Address - Phone:920-563-8280
Practice Address - Fax:920-563-1494
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15372-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31094200Medicaid
WI31094200Medicaid
WI002030345Medicare PIN
WI31094200Medicaid