Provider Demographics
NPI:1285197418
Name:BAUER, JOHN WILLIAM
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:BAUER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11496 N PORKYS RD
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-6362
Mailing Address - Country:US
Mailing Address - Phone:715-634-6895
Mailing Address - Fax:
Practice Address - Street 1:15657 W COUNTY HIGHWAY B
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-2680
Practice Address - Country:US
Practice Address - Phone:715-558-3528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator