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General NPI Number Information
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NPI Number | 1174027882
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Entity Type | Individual
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Provider Name | TYLER MARQUES BAUMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 10050 S 27TH ST STE 200
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City | OAK CREEK
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State | WI
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Zip | 53154-5522
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Country | US
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Telephone | 262-754-4488
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Fax |
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Provider Business Mailing Address
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Address Line | N6032 FIEDLER RD
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City | ALBANY
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State | WI
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Zip | 53502-9580
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Country | US
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Telephone | 414-369-2369
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 82390-20
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License Number State | WI
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