Provider Demographics
NPI:1225146319
Name:BAUMAN-BORK, MARCEIL D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCEIL
Middle Name:D
Last Name:BAUMAN-BORK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 SW BELLE AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-1771
Mailing Address - Country:US
Mailing Address - Phone:785-272-5566
Mailing Address - Fax:785-272-5967
Practice Address - Street 1:2110 SW BELLE AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-1771
Practice Address - Country:US
Practice Address - Phone:785-272-5566
Practice Address - Fax:785-272-5967
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04205372084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100777OtherBLUE SHIELD
KS100777OtherBLUE SHIELD