Provider Demographics
NPI:1649296872
Name:BATEMAN, RANDALL JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:JOHN
Last Name:BATEMAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-286-1967
Mailing Address - Fax:314-286-1985
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DIV NEURO AGING AND DEMENTIA, STE 6C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-286-1967
Practice Address - Fax:314-286-1985
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040085462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209158104Medicaid
ILENROLLEDMedicaid
MO919830101Medicare PIN
MOP00239318Medicare PIN