Healthcare Provider Details

I. General information

NPI: 1902806326
Provider Name (Legal Business Name): JERRY BAUER MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/21/2022
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 W DEMPSTER SUITE 605
PARK RIDGE IL
60068-1168
US

IV. Provider business mailing address

1875 W DEMPSTER SUITE 605
PARK RIDGE IL
60068-1168
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 Number
License Number StateIL

VIII. Authorized Official

Name: LISA M LABBATE
Title or Position: OFFICE MGR
Credential:
Phone: 847-698-1088