Provider Demographics
NPI:1457391658
Name:BAUER, JOHN J (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:BAUER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4771 OAKHURST RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-5049
Mailing Address - Country:US
Mailing Address - Phone:810-232-8888
Mailing Address - Fax:810-232-9190
Practice Address - Street 1:1121 W HILL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-4733
Practice Address - Country:US
Practice Address - Phone:810-232-8888
Practice Address - Fax:810-232-9190
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301053705208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
571453OtherSELECTCARE
MIH20425OtherHAP
MI0988374OtherHEALTHPLUS OF MICHIGAN
MIC7175OtherMCARE
MI102446OtherMCLAREN HEALTHPLAN
MIH20425OtherHAP
H20425Medicare UPIN