Provider Demographics
NPI:1083602510
Name:BACH, JANET M (DO)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:M
Last Name:BACH
Suffix:
Gender:F
Credentials:DO
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 265
Mailing Address - Street 2:
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-0265
Mailing Address - Country:US
Mailing Address - Phone:989-652-5220
Mailing Address - Fax:989-652-3741
Practice Address - Street 1:1027 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-1302
Practice Address - Country:US
Practice Address - Phone:989-652-5220
Practice Address - Fax:989-652-3741
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJB010243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4392101OtherAETNA
MI0983111OtherHEALTHPLUS OF MI
MI5730042OtherBLUE CROSS BLUE SHIELD MI
MI4129497Medicaid
MI5730042OtherBLUE CROSS BLUE SHIELD MI
MI4129497Medicaid