Provider Demographics
NPI:1477586840
Name:BAIETTO, EDWARD BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:BERNARD
Last Name:BAIETTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:15119 CHAMISAL DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-7723
Mailing Address - Country:US
Mailing Address - Phone:636-532-4112
Mailing Address - Fax:636-532-4136
Practice Address - Street 1:15119 CHAMISAL DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-7723
Practice Address - Country:US
Practice Address - Phone:636-532-4112
Practice Address - Fax:636-532-4136
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3240207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine