Healthcare Provider Details

I. General information

NPI: 1063289593
Provider Name (Legal Business Name): DR. JOHN C BAUMAN MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 CROOKS RD
ROYAL OAK MI
48067-1301
US

IV. Provider business mailing address

1121 CROOKS RD
ROYAL OAK MI
48067-1301
US

V. Phone/Fax

Practice location:
  • Phone: 248-541-7023
  • Fax:
Mailing address:
  • Phone: 248-541-7023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: GINGER KLEINERT
Title or Position: PRACTICE MANAGER
Credential:
Phone: 248-541-7023