Healthcare Provider Details

I. General information

NPI: 1265400717
Provider Name (Legal Business Name): AUDREY G BAUER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AUDREY G BOLANOWSKI MD

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 MANATEE AVE W STE 105
BRADENTON FL
34205-8624
US

IV. Provider business mailing address

701 MANATEE AVE W STE 105
BRADENTON FL
34205-8624
US

V. Phone/Fax

Practice location:
  • Phone: 727-787-4379
  • Fax: 727-228-4542
Mailing address:
  • Phone: 727-787-4379
  • Fax: 727-228-4542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number166726
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number145718
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0053119
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: