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Individual

PAUL R BATTY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1340 CHARLES ST STE 100, ROCKFORD, IL 61104-2200
(779) 696-8700
Mailing address
PO BOX 78866, MILWAUKEE, WI 53278-8866
(779) 696-7150

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036082625
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036082625
IL
01
206147
MEDICARE GROUP PTAN
IL
01
CA4748
MEDICARE RAILROAD GROUP PTAN
IL
01
F400165384
MEDICARE INDIVIDUAL PTAN
IL
01
P01398548
MEDICARE RAILROAD
IL
Enumeration date
06/16/2005
Last updated
03/11/2021
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