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NPI Code Detail

MEDICARE: ABBEY THEREASA BAUS PA

MEDICARE: ABBEY THEREASA BAUS PA
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
1363A00000XPhysician Assistant085005763IL

General Provider Information

NPI Number : 1477911782
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABBEY THEREASA BAUS PA
Provider Business Mailing Address
First Line : 3245 N HALSTED ST
Second Line :
City : CHICAGO
State : IL
Zip : 60657-3419
Country : US
Telephone Number : 773-296-8400
Fax Number : 773-388-1602
Provider Business Practice Location Address
First Line : 3245 N HALSTED ST
Second Line :
City : CHICAGO
State : IL
Zip : 60657-3419
Country : US
Telephone Number : 773-296-8400
Fax Number : 773-388-1602
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2016
Last Update Date : 02/26/2016

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Directions to “ ABBEY THEREASA BAUS PA” Practice Location

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