Provider Demographics
NPI:1811937410
Name:BAUER, KAREN ANN (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:BAUER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4685 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3397
Mailing Address - Country:US
Mailing Address - Phone:132-467-0000
Mailing Address - Fax:
Practice Address - Street 1:379 DIXMYTH AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2475
Practice Address - Country:US
Practice Address - Phone:132-467-0005
Practice Address - Fax:513-246-7590
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39182207RP1001X
IN01037574A207RP1001X
OH35050830207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64930878Medicaid
OHH648890OtherMEDICARE PTAN
OH0740774Medicaid
IN000000879842OtherANTHEM PROVIDER NUMBER
IN100318160Medicaid
KYK006140Medicare PIN
KY64930878Medicaid
IN100318160Medicaid
OH0740774Medicaid
OHP00415713Medicare PIN