Provider Demographics
NPI:1518946573
Name:BAERG, CAROLINE T (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:T
Last Name:BAERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 E MAIN ST
Mailing Address - Street 2:PO BOX 8674
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5066
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:
Practice Address - Street 1:1230 E MAIN ST
Practice Address - Street 2:MANKATO CLINIC AT MAIN STREET
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5066
Practice Address - Country:US
Practice Address - Phone:507-625-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN37939207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN111432OtherUCARE
MN0101410OtherMEDICA
MN678819000Medicaid
080073102OtherRR MEDICARE
MN658409OtherAMERICAS PPO
MNHP24187OtherHEALTH PARTNERS
MNNA2951023812OtherPREFERRED ONE
IA0964965Medicaid
41084933956001C092OtherCHAMPUS
MN6K885BAOtherBCBS
MN089002472Medicare PIN
MN6K885BAOtherBCBS