Healthcare Provider Details

I. General information

NPI: 1083602510
Provider Name (Legal Business Name): JANET M BACH D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 W GENESEE ST
FRANKENMUTH MI
48734-1302
US

IV. Provider business mailing address

PO BOX 265
FRANKENMUTH MI
48734-0265
US

V. Phone/Fax

Practice location:
  • Phone: 989-652-5220
  • Fax: 989-652-3741
Mailing address:
  • Phone: 989-652-5220
  • Fax: 989-652-3741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJB010243
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: