Provider Demographics
NPI:1689038671
Name:BAUTISTA, MICHAEL JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSE
Last Name:BAUTISTA
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 1:129 KINGS HWY N
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-2438
Mailing Address - Country:US
Mailing Address - Phone:203-227-4113
Mailing Address - Fax:203-226-6718
Practice Address - Street 1:129 KINGS HWY N
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-2438
Practice Address - Country:US
Practice Address - Phone:203-227-4113
Practice Address - Fax:203-226-6718
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT69814207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology