Provider Demographics
NPI:1710981485
Name:BAUTISTA, MARIA H (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:H
Last Name:BAUTISTA
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 1:1039 HASKINS RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-9065
Mailing Address - Country:US
Mailing Address - Phone:419-352-1121
Mailing Address - Fax:419-352-1179
Practice Address - Street 1:1039 HASKINS RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-9065
Practice Address - Country:US
Practice Address - Phone:419-352-1121
Practice Address - Fax:419-352-1179
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35036596B208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0417418Medicaid
OHD33724Medicare UPIN
OH0417418Medicaid