Provider Demographics
NPI:1568457059
Name:BAUWENS, DALE E (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:E
Last Name:BAUWENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2500 N MAYFAIR RD
Mailing Address - Street 2:STE 500
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1409
Mailing Address - Country:US
Mailing Address - Phone:414-257-2525
Mailing Address - Fax:414-257-1772
Practice Address - Street 1:2500 N MAYFAIR RD
Practice Address - Street 2:STE 500
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1409
Practice Address - Country:US
Practice Address - Phone:414-257-2525
Practice Address - Fax:414-257-1772
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI22964207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30582200Medicaid
WI30582200Medicaid
WI00201833Medicare PIN
WI1009700001Medicare NSC