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NPI Code Detail

MEDICARE: THERESA BAUER

MEDICARE: THERESA BAUER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1124Q00000XDental HygienistIL

General Provider Information

NPI Number : 1023299724
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA BAUER
Provider Business Mailing Address
First Line : 233 W JOE ORR RD
Second Line :
City : CHICAGO HEIGHTS
State : IL
Zip : 60411-1744
Country : US
Telephone Number : 708-754-1044
Fax Number : 708-747-3497
Provider Business Practice Location Address
First Line : 233 W JOE ORR RD
Second Line :
City : CHICAGO HEIGHTS
State : IL
Zip : 60411-1744
Country : US
Telephone Number : 708-754-1044
Fax Number : 708-747-3497
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2007
Last Update Date : 11/21/2007

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Directions to “ THERESA BAUER ” Practice Location

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