Provider Demographics
NPI:1083607691
Name:BAUER, RAYMOND T (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:T
Last Name:BAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8301 RELIABLE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0083
Mailing Address - Country:US
Mailing Address - Phone:586-498-2400
Mailing Address - Fax:586-498-2800
Practice Address - Street 1:25311 LITTLE MACK AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-3370
Practice Address - Country:US
Practice Address - Phone:586-498-2400
Practice Address - Fax:586-498-2800
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301062448208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1083607691Medicaid
MIF34965006Medicare ID - Type Unspecified
MI4301062448OtherMICHIGAN LICENSE
G53199Medicare UPIN