Provider Demographics
NPI:1700834884
Name:BAUER, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:BAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5233 W. MORGAN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53220-1559
Mailing Address - Country:US
Mailing Address - Phone:414-321-8960
Mailing Address - Fax:414-321-0632
Practice Address - Street 1:5233 W. MORGAN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53220-1559
Practice Address - Country:US
Practice Address - Phone:414-321-8960
Practice Address - Fax:414-321-0632
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI18931174400000X
WI18931020207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30224300Medicaid
WI000468309Medicare PIN
WI1222470002Medicare NSC
WI000001077Medicare ID - Type Unspecified
WI30224300Medicaid
WI1222470001Medicare NSC
WI000602670Medicare Oscar/Certification