MEDICARE: DR. JOHN A BATES D.O

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	208600000X	Surgery Physician	5101021609	MI
2	2086S0122X	Plastic and Reconstructive Surgery Physician	5151010443	MI
3	2086S0122X	Plastic and Reconstructive Surgery Physician	89538	SC

General Provider Information

NPI Number	:	1326425059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN A BATES D.O

Provider Business Mailing Address
First Line	:	28050 GRAND RIVER AVE
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48336-5919
Country	:	US
Telephone Number	:	248-888-2516
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 BLANDING ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2816
Country	:	US
Telephone Number	:	803-234-2010
Fax Number	:

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

Provider Enumeration Date	:	05/01/2015
Last Update Date	:	06/14/2023

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