Provider Demographics
NPI:1497799977
Name:BAUER, MICHAEL BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRIAN
Last Name:BAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 MALCOLM BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CONNELLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28612-8079
Mailing Address - Country:US
Mailing Address - Phone:828-580-7962
Mailing Address - Fax:828-580-3392
Practice Address - Street 1:730 MALCOLM BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CONNELLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28612-8079
Practice Address - Country:US
Practice Address - Phone:828-580-7962
Practice Address - Fax:828-580-3392
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900164208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891277YMedicaid
NC1227YOtherBCBS
NC1497799977Medicaid
NC891277YMedicaid
NC2275570Medicare ID - Type Unspecified