Provider Demographics
NPI:1174027882
Name:BAUMAN, TYLER MARQUES (MD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:MARQUES
Last Name:BAUMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N6032 FIEDLER RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:WI
Mailing Address - Zip Code:53502-9580
Mailing Address - Country:US
Mailing Address - Phone:414-369-2369
Mailing Address - Fax:
Practice Address - Street 1:10050 S 27TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-5522
Practice Address - Country:US
Practice Address - Phone:262-754-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0070048207N00000X
KY55530207N00000X
390200000X
OH35.144717207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program