Healthcare Provider Details

I. General information

NPI: 1144386624
Provider Name (Legal Business Name): PENNY S BAUMEIER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8548 W GRAND RIVER AVE
BRIGHTON MI
48116-2326
US

IV. Provider business mailing address

8548 W GRAND RIVER AVE
BRIGHTON MI
48116-2326
US

V. Phone/Fax

Practice location:
  • Phone: 810-229-7257
  • Fax:
Mailing address:
  • Phone: 810-229-7257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101012625
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: