Provider Demographics
NPI:1639404171
Name:MIDWEST DYSPHAGIA CONSULTANTS, LLC
Entity Type:Organization
Organization Name:MIDWEST DYSPHAGIA CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOM
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-275-1834
Mailing Address - Street 1:1717 ROTARY DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-5235
Mailing Address - Country:US
Mailing Address - Phone:281-272-6277
Mailing Address - Fax:281-272-6281
Practice Address - Street 1:5710 WOOSTER PIKE STE 102
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-4520
Practice Address - Country:US
Practice Address - Phone:281-272-6277
Practice Address - Fax:281-272-6277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty