Healthcare Provider Details

I. General information

NPI: 1932198926
Provider Name (Legal Business Name): DONALD BRUCE BAEUCHLER
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 W FOSTER AVE SUITE 101
CHICAGO IL
60625-3500
US

IV. Provider business mailing address

1835 STEWART AVE
PARK RIDGE IL
60068-3858
US

V. Phone/Fax

Practice location:
  • Phone: 773-989-6280
  • Fax:
Mailing address:
  • Phone: 847-696-2489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: