Healthcare Provider Details

I. General information

NPI: 1861089526
Provider Name (Legal Business Name): MICHAEL TERRENCE BATTAG;OA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 W CENTRAL ENTRANCE
DULUTH MN
55811-5448
US

IV. Provider business mailing address

615 W CENTRAL ENTRANCE
DULUTH MN
55811-5448
US

V. Phone/Fax

Practice location:
  • Phone: 218-727-3010
  • Fax: 218-727-7586
Mailing address:
  • Phone: 218-727-3010
  • Fax: 218-727-7586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number113010
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: