Provider Demographics
NPI:1871526681
Name:BATKOFF, BRADEN WILLIAM (MD, FACC)
Entity type:Individual
Prefix:
First Name:BRADEN
Middle Name:WILLIAM
Last Name:BATKOFF
Suffix:
Gender:
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31001-4114
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-0001
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:
Practice Address - Street 1:62 W 7TH AVE STE 450
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2321
Practice Address - Country:US
Practice Address - Phone:509-455-8820
Practice Address - Fax:509-838-4978
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD-29742207RC0000X
WAMD00029742207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA060036862OtherRRB
ID003152400Medicaid
WA8147555Medicaid
WA8147555Medicaid
WAG000357314Medicare PIN
G16761Medicare UPIN