Provider Demographics
NPI:1972682367
Name:BADER, JILL MARIE (MD)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:MARIE
Last Name:BADER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JILL
Other - Middle Name:BADER
Other - Last Name:SOLEAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:500 RUE DE LA VIE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-5126
Mailing Address - Country:US
Mailing Address - Phone:225-201-2000
Mailing Address - Fax:225-201-2110
Practice Address - Street 1:500 RUE DE LA VIE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-5126
Practice Address - Country:US
Practice Address - Phone:225-201-2000
Practice Address - Fax:225-201-2110
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48937-020207V00000X
LA202310207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1187321Medicaid
WIJBADEROtherMD