Provider Demographics
NPI:1437209053
Name:BAER, MICHAEL ALAN (PH D)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALAN
Last Name:BAER
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 TAMIAMI TRL S
Mailing Address - Street 2:SUITE # 206
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-4133
Mailing Address - Country:US
Mailing Address - Phone:941-485-6300
Mailing Address - Fax:941-485-6233
Practice Address - Street 1:1101 TAMIAMI TRL S
Practice Address - Street 2:SUITE # 206
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-4133
Practice Address - Country:US
Practice Address - Phone:941-485-6300
Practice Address - Fax:941-485-6233
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7021103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY7021Medicare UPIN