Provider Demographics
NPI:1528490372
Name:BATENGA, BERNOLE VALDEZ (MD)
Entity type:Individual
Prefix:DR
First Name:BERNOLE
Middle Name:VALDEZ
Last Name:BATENGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-983-3492
Mailing Address - Fax:765-983-7958
Practice Address - Street 1:1100 REID PKWY
Practice Address - Street 2:REID HOSPITAL & HEALTH CARE SERVICES
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1157
Practice Address - Country:US
Practice Address - Phone:765-983-3492
Practice Address - Fax:765-983-7958
Is Sole Proprietor?:No
Enumeration Date:2013-08-04
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN01076093A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGOtherANTHEM
INPENDINGMedicaid
OHPENDINGMedicaid
INPENDINGMedicare PIN