Healthcare Provider Details

I. General information

NPI: 1427366814
Provider Name (Legal Business Name): LEIGH F BAUER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 01/14/2024
Certification Date: 01/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10339 DAWSONS CREEK BLVD
FORT WAYNE IN
46825-1907
US

IV. Provider business mailing address

PO BOX 772437
DETROIT MI
48277-2437
US

V. Phone/Fax

Practice location:
  • Phone: 260-999-7147
  • Fax: 888-578-2674
Mailing address:
  • Phone: 317-575-7304
  • Fax: 317-575-7333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number02006131
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number55554
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number55554
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number02006131A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: