Provider Demographics
NPI:1023039377
Name:BATTIS, GEORGE NICHOLAS JR (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:NICHOLAS
Last Name:BATTIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GEORGE
Other - Middle Name:NICHOLAS
Other - Last Name:BATTIS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:400 ROBERT ST N # 13-3996
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2037
Mailing Address - Country:US
Mailing Address - Phone:651-665-3996
Mailing Address - Fax:651-665-5960
Practice Address - Street 1:400 ROBERT ST N # 13-3996
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2037
Practice Address - Country:US
Practice Address - Phone:651-665-3996
Practice Address - Fax:651-665-5960
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24750207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA93847Medicare UPIN