Provider Demographics
NPI:1174691604
Name:BATCHU, MADHU M (MD)
Entity type:Individual
Prefix:
First Name:MADHU
Middle Name:M
Last Name:BATCHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 W CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4828
Mailing Address - Country:US
Mailing Address - Phone:269-324-4141
Mailing Address - Fax:269-324-2020
Practice Address - Street 1:2600 W CENTRE AVE
Practice Address - Street 2:BOX 42
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4828
Practice Address - Country:US
Practice Address - Phone:269-324-4141
Practice Address - Fax:269-324-2020
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067972207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MB067972OtherCOMMERCIAL-COMMERCIAL NUMBER
MI1174691604Medicaid
MB067972OtherCHAMPUS-CHAMPUS
MI413407610Medicaid
MI1104840529OtherBCBSM - BPM
700H262220OtherBLUE CROSS-BLUE CROSS
700H262220OtherBLUE CROSS-BLUE CROSS
MI1174691604Medicaid
MIM20520101 BPMMedicare PIN