MEDICARE: DR. PENNY S BAUMEIER D.O.

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
1	208000000X	Pediatrics Physician	5101012625	MI

General Provider Information

NPI Number	:	1144386624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PENNY S BAUMEIER D.O.

Provider Business Mailing Address
First Line	:	8548 W GRAND RIVER AVE
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48116-2326
Country	:	US
Telephone Number	:	810-229-7257
Fax Number	:

Provider Business Practice Location Address
First Line	:	8548 W GRAND RIVER AVE
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48116-2326
Country	:	US
Telephone Number	:	810-229-7257
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	11/27/2012

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