Provider Demographics
NPI:1295799419
Name:BAUER, L A (MD PC)
Entity type:Individual
Prefix:DR
First Name:L A
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 226
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-0226
Mailing Address - Country:US
Mailing Address - Phone:812-934-4619
Mailing Address - Fax:812-934-6108
Practice Address - Street 1:321 MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-8909
Practice Address - Country:US
Practice Address - Phone:812-934-4619
Practice Address - Fax:812-934-6108
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031834A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100211720AMedicaid
INBA700980Medicare ID - Type Unspecified
IN100211720AMedicaid