Provider Demographics
NPI:1164447975
Name:HAN SOO BAE PLLC
Entity Type:Organization
Organization Name:HAN SOO BAE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTOLARYGNOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:HAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-354-2191
Mailing Address - Street 1:2079 US HIGHWAY 23 S
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-4524
Mailing Address - Country:US
Mailing Address - Phone:989-354-2191
Mailing Address - Fax:989-356-0784
Practice Address - Street 1:2079 US HIGHWAY 23 S
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-4524
Practice Address - Country:US
Practice Address - Phone:989-354-2191
Practice Address - Fax:989-356-0784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075954207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5194963Medicaid
MI5194963Medicaid