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NPI Code Detail

MEDICARE: ELIZABETH B BAUER MD

MEDICARE: ELIZABETH B BAUER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician35086274OH
2208000000XPediatrics Physician7536SD

General Provider Information

NPI Number : 1124024153
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH B BAUER MD
Provider Business Mailing Address
First Line : PO BOX 5074
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57117-5074
Country : US
Telephone Number : 605-312-7605
Fax Number : 605-312-7611
Provider Business Practice Location Address
First Line : 4405 E 26TH ST
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57103-4187
Country : US
Telephone Number : 605-328-9080
Fax Number : 605-328-9081
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2005
Last Update Date : 12/07/2011

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