Provider Demographics
NPI:1184731333
Name:BAER, WILLIAM HENRY II (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HENRY
Last Name:BAER
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 44TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5008
Mailing Address - Country:US
Mailing Address - Phone:616-685-1808
Mailing Address - Fax:616-685-8099
Practice Address - Street 1:260 JEFFERSON AVE SE
Practice Address - Street 2:SUITE 115
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4597
Practice Address - Country:US
Practice Address - Phone:616-685-3100
Practice Address - Fax:616-685-3111
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1104107932OtherBCBS OF MICHIGAN
MI3471741Medicaid
38-2145264OtherIRS TAX ID # THRU CORP
MI3471741Medicaid
G76095Medicare UPIN