Provider Demographics
NPI:1285738435
Name:BATES, JOEL DOUGLAS (DO)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:DOUGLAS
Last Name:BATES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 STURDY RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-4126
Mailing Address - Country:US
Mailing Address - Phone:219-462-7173
Mailing Address - Fax:219-462-7504
Practice Address - Street 1:1001 STURDY RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4126
Practice Address - Country:US
Practice Address - Phone:219-462-7173
Practice Address - Fax:219-462-7504
Is Sole Proprietor?:No
Enumeration Date:2006-09-09
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013835207Q00000X
IN02006581A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300057704Medicaid
MI4750822-11Medicaid
MI1285738435Medicaid
MIH47587Medicare UPIN
OD16299062Medicare PIN
MI1285738435Medicaid