Healthcare Provider Details

I. General information

NPI: 1710146576
Provider Name (Legal Business Name): DAVID VINCENT BAEWER MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MINERAL POINT AVE
JANESVILLE WI
53548-2940
US

IV. Provider business mailing address

1000 MINERAL POINT AVE
JANESVILLE WI
53548-2940
US

V. Phone/Fax

Practice location:
  • Phone: 608-756-6761
  • Fax: 608-756-6572
Mailing address:
  • Phone: 608-756-6761
  • Fax: 608-756-6572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number56809-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: