Healthcare Provider Details

I. General information

NPI: 1609281690
Provider Name (Legal Business Name): JOHN BAUMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 08/31/2024
Certification Date: 08/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 CROOKS RD
ROYAL OAK MI
48067-1382
US

IV. Provider business mailing address

1121 CROOKS RD
ROYAL OAK MI
48067-1382
US

V. Phone/Fax

Practice location:
  • Phone: 248-541-8554
  • Fax: 217-545-1793
Mailing address:
  • Phone: 248-541-8554
  • Fax: 217-545-1793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125.064980
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number4301119290
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: