MEDICARE: TERRY SCOTT BAUL 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	208D00000X	General Practice Physician	4301042171	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942375837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY SCOTT BAUL M.D.

Provider Business Mailing Address
First Line	:	17751 E WARREN AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48224-1329
Country	:	US
Telephone Number	:	313-885-6833
Fax Number	:	313-885-1268

Provider Business Practice Location Address
First Line	:	17751 E WARREN AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48224-1329
Country	:	US
Telephone Number	:	313-885-6833
Fax Number	:	313-885-1268

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

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	12/19/2007

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