Basic Information
| Provider Information | |||||||||
| NPI: | 1316011075 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BATTLES | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5915 THORNDALE DR | ||||||||
| Address2: | |||||||||
| City: | KENT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442404817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306783455 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9318 STATE ROUTE 14 | ||||||||
| Address2: | FIRST FLOOR | ||||||||
| City: | STREETSBORO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442415224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306263455 | ||||||||
| FaxNumber: | 3306264189 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 02/05/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34-003308 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0520510 | 05 | OH | MEDICAID |