Healthcare Provider Details

I. General information

NPI: 1891789657
Provider Name (Legal Business Name): EDWARD D BAYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 LAWRENCE DR
DE PERE WI
54115-9108
US

IV. Provider business mailing address

1716 LAWRENCE DR
DE PERE WI
54115-9108
US

V. Phone/Fax

Practice location:
  • Phone: 920-605-3115
  • Fax: 920-486-6826
Mailing address:
  • Phone: 920-605-3115
  • Fax: 920-486-6826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38740
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: