MEDICARE: JOHN BAENZIGER M.D.

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
1	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	01029176A	IN

General Provider Information

NPI Number	:	1326005182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BAENZIGER M.D.

Provider Business Mailing Address
First Line	:	635 BARNHILL DR
Second Line	:	A128
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5126
Country	:	US
Telephone Number	:	317-274-4806
Fax Number	:

Provider Business Practice Location Address
First Line	:	635 BARNHILL DR
Second Line	:	A128
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5126
Country	:	US
Telephone Number	:	317-274-4806
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	07/08/2007

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