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NPI Code Detail

MEDICARE: CAROL M BAUER M.D.

MEDICARE: CAROL M BAUER M.D.
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
1207Y00000XOtolaryngology Physician036091175IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700871571
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROL M BAUER M.D.
Provider Business Mailing Address
First Line : 720 N BOND ST
Second Line : PO BOX 19639
City : SPRINGFIELD
State : IL
Zip : 62794
Country : US
Telephone Number : 217-545-8000
Fax Number :
Provider Business Practice Location Address
First Line : 301 N 8TH ST
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62701-1041
Country : US
Telephone Number : 217-545-6099
Fax Number : 217-545-0253
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2005
Last Update Date : 02/18/2020

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