Provider Demographics
NPI:1174681530
Name:BAUBLY, PAUL MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:MICHAEL
Last Name:BAUBLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2923
Mailing Address - Country:US
Mailing Address - Phone:630-595-9988
Mailing Address - Fax:331-225-2296
Practice Address - Street 1:103 N HAVEN RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2923
Practice Address - Country:US
Practice Address - Phone:630-595-9988
Practice Address - Fax:331-225-2296
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036082085207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2201770OtherBLUE CROSS
IL036082085Medicaid
IL036082085Medicaid
2201770OtherBLUE CROSS