MEDICARE: DR. TODD RATHKE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2901018260	MI

General Provider Information

NPI Number	:	1487634093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD RATHKE DDS

Provider Business Mailing Address
First Line	:	1001 MULHOLLAND ST
Second Line	:	SUITE #1
City	:	BAY CITY
State	:	MI
Zip	:	48708-7646
Country	:	US
Telephone Number	:	989-894-0061
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 MULHOLLAND ST
Second Line	:	SUITE #1
City	:	BAY CITY
State	:	MI
Zip	:	48708-7646
Country	:	US
Telephone Number	:	989-894-0061
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	07/08/2007

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