Healthcare Provider Details

I. General information

NPI: 1861490427
Provider Name (Legal Business Name): JERRY BAUER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 DEMPSTER ST STE 605
PARK RIDGE IL
60068-1186
US

IV. Provider business mailing address

1875 DEMPSTER ST STE 605
PARK RIDGE IL
60068-1186
US

V. Phone/Fax

Practice location:
  • Phone: 847-698-1088
  • Fax: 847-698-1087
Mailing address:
  • Phone: 847-698-1088
  • Fax: 847-698-1087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number036-051192
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: