MEDICARE: TODD RATHKE DDS, PLC

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	:	1912274531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TODD RATHKE DDS, PLC

Provider Business Mailing Address
First Line	:	2272 21ST ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-7407
Country	:	US
Telephone Number	:	989-894-0061
Fax Number	:	989-894-0269

Provider Business Practice Location Address
First Line	:	2272 21ST ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-7407
Country	:	US
Telephone Number	:	989-894-0061
Fax Number	:	989-894-0269

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. TODD RATHKE
Credential	:	DDS
Telephone Number	:	989-894-0061

Provider Enumeration Date	:	11/28/2011
Last Update Date	:	11/28/2011

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