MEDICARE: JEREMIAH LEE BAUER PA-C

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	363A00000X	Physician Assistant		OH

General Provider Information

NPI Number	:	1740750173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMIAH LEE BAUER PA-C

Provider Business Mailing Address
First Line	:	9500 EUCLID AVE.
Second Line	:	M2 ANNEX
City	:	CLEVELAND
State	:	OH
Zip	:	44195
Country	:	US
Telephone Number	:	216-445-1472
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-2965
Country	:	US
Telephone Number	:	216-445-1472
Fax Number	:

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

Provider Enumeration Date	:	11/28/2018
Last Update Date	:	04/11/2020

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