Provider Demographics
NPI:1336400167
Name:BATTJES, ABIGAIL M (DO)
Entity Type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:M
Last Name:BATTJES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:ABIGAIL
Other - Middle Name:M
Other - Last Name:PRAST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:707 CEDAR ST STE 405
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2059
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1122 S IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-1618
Practice Address - Country:US
Practice Address - Phone:574-335-8399
Practice Address - Fax:574-335-0786
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11016650A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201111580Medicaid
IN1102447818OtherANTHEM