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General NPI Number Information
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NPI Number | 1164447975
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Entity Type | Organization
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Legal Business Name | HAN SOO BAE PLLC
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 02/25/2008
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Provider Practice Location Address
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Address Line | 2079 US HIGHWAY 23 S
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City | ALPENA
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State | MI
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Zip | 49707-4524
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Country | US
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Telephone | 989-354-2191
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Fax | 989-356-0784
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Provider Business Mailing Address
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Address Line | 2079 US HIGHWAY 23 S
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City | ALPENA
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State | MI
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Zip | 49707-4524
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Country | US
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Telephone | 989-354-2191
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Fax | 989-356-0784
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Authorized Official
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Title or Position | OTOLARYGNOLOGY
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Name | DR. HAN BAE
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Credential | M.D.
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Telephone | 989-354-2191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 4301075954
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License Number State | MI
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