Healthcare Provider Details

I. General information

NPI: 1184731333
Provider Name (Legal Business Name): WILLIAM HENRY BAER II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 JEFFERSON AVE SE SUITE 115
GRAND RAPIDS MI
49503-4597
US

IV. Provider business mailing address

1900 44TH ST SE
GRAND RAPIDS MI
49508-5008
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-3100
  • Fax: 616-685-3111
Mailing address:
  • Phone: 616-685-1808
  • Fax: 616-685-8099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301065896
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: