Basic Information
| Provider Information | |||||||||
| NPI: | 1013974997 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BACHTEL | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | DALE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 812 KINGS CROSS | ||||||||
| Address2: | |||||||||
| City: | TALLMADGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442781175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306300866 | ||||||||
| FaxNumber: | 3306300520 | ||||||||
| Practice Location | |||||||||
| Address1: | 182 EAST AVE | ||||||||
| Address2: | |||||||||
| City: | TALLMADGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442782311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303609726 | ||||||||
| FaxNumber: | 3306302194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 02/18/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35-048309 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0541284 | 05 | OH | MEDICAID |