Basic Information
Provider Information
NPI: 1780267641
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BATSON
FirstName: IAN
MiddleName: SAMUEL
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1200 E MICHIGAN AVE STE 245
Address2:  
City: LANSING
State: MI
PostalCode: 489121897
CountryCode: US
TelephoneNumber: 5173645710
FaxNumber:  
Practice Location
Address1: 1215 E MICHIGAN AVE
Address2:  
City: LANSING
State: MI
PostalCode: 489121896
CountryCode: US
TelephoneNumber: 5173642583
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/29/2021
LastUpdateDate: 11/05/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/05/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X5151014885MIY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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