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Individual

BRENDA GAYLE BACHMANN

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
P.A.

Contact information

Practice address
640 INDUSTRIAL PKWY, ELKHART, IN 46516-5414
(574) 522-7203
(574) 522-7405
Mailing address
640 INDUSTRIAL PKWY, ELKHART, IN 46516-5414
(574) 522-7203
(574) 522-7405

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10000514A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000329042
BLUE CROSS/BLUE SHIELD
IN
01
P00134721
RAILROAD MEDICARE
IN
Enumeration date
06/24/2005
Last updated
07/08/2007
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