Provider Demographics
NPI:1740256064
Name:BAHNTGE, MICHAEL FREDERICK (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FREDERICK
Last Name:BAHNTGE
Suffix:
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 1:20525 CENTER RIDGE RD
Mailing Address - Street 2:STE 220
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116
Mailing Address - Country:US
Mailing Address - Phone:440-895-5056
Mailing Address - Fax:440-333-2935
Practice Address - Street 1:2500 METROHEALTH DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1900
Practice Address - Country:US
Practice Address - Phone:216-778-3958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2018-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048477B2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
11046868OtherCAQH
CA4511OtherRR MEDICARE GROUP
D368301OtherGROUP IND DIAGNOSTICS MED
9273172OtherGROUP MEDICARE
0119204OtherGROUP MEDICAID
OH0587931Medicaid
1780634279OtherGROUPNPI
4326122OtherAETNA
CA4511OtherGROUP RR MEDICARE
000000276513OtherANTHEM
0501231OtherUNITED HEALTHCARE
341783789031OtherCARESOURCE
C78477OtherSUMMACARE APEX
3610861OtherGROUP ASC MEDICARE
103647OtherKAISER
130026262OtherRR MEDICARE INDIVIDUAL
11046868OtherCAQH
3610861OtherGROUP ASC MEDICARE
4326122OtherAETNA