Provider Demographics
NPI:1508003997
Name:BAUER, KRISTEL E (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEL
Middle Name:E
Last Name:BAUER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 N SHORE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-2225
Mailing Address - Country:US
Mailing Address - Phone:847-615-1698
Mailing Address - Fax:847-615-1697
Practice Address - Street 1:900 N SHORE DR STE 120
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-2225
Practice Address - Country:US
Practice Address - Phone:847-615-1698
Practice Address - Fax:847-615-1697
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1072528363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant