Healthcare Provider Details

I. General information

NPI: 1942475678
Provider Name (Legal Business Name): DANIEL R BATEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3707 DOTY RD STE A
WOODSTOCK IL
60098-7530
US

IV. Provider business mailing address

3707 DOTY RD STE A
WOODSTOCK IL
60098-7530
US

V. Phone/Fax

Practice location:
  • Phone: 815-334-5018
  • Fax: 815-337-5499
Mailing address:
  • Phone: 815-334-5018
  • Fax: 815-337-5499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number390200000X
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01075387A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number0420011789
License Number StateVT
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036162029
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0420011789
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: