Provider Demographics
NPI:1922128222
Name:BAUER, MELISSA E (DO)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:E
Last Name:BAUER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:BALUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:700 KMS PLACE
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108
Mailing Address - Country:US
Mailing Address - Phone:734-936-2047
Mailing Address - Fax:
Practice Address - Street 1:1500 E MEDICAL CENTER DR
Practice Address - Street 2:1H247 UNIVERSITY HOSPITAL
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5048
Practice Address - Country:US
Practice Address - Phone:734-936-4280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5551207L00000X
MI5101016355207L00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2168767-01Medicaid
TX8CL171OtherBLUE CROSS BLUE SHITLD
TX2168767-01Medicaid