Provider Demographics
NPI:1922053685
Name:BAUER, JAMES J (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
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 1:785 NORTH LAPEER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362
Mailing Address - Country:US
Mailing Address - Phone:248-693-4271
Mailing Address - Fax:248-693-4663
Practice Address - Street 1:1251 S LAPEER RD STE 202
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1416
Practice Address - Country:US
Practice Address - Phone:248-693-4271
Practice Address - Fax:248-693-4663
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJB053102207PE0004X
MI4301053102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIJB053102OtherBCBS
MI104153797Medicaid
MI4249495Medicaid
E80238Medicare UPIN
MI0N14950Medicare ID - Type Unspecified
MI104153797Medicaid
MI4249495Medicaid