Healthcare Provider Details

I. General information

NPI: 1952605503
Provider Name (Legal Business Name): PENNY S. BAUMEIER DO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2010
Last Update Date: 12/22/2010
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: 810-229-4069
Mailing address:
  • Phone: 810-229-7257
  • Fax: 810-229-4069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PENNY S BAUMEIER DO
Title or Position: OWNER
Credential:
Phone: 810-229-7257