Basic Information
| Provider Information | |||||||||
| NPI: | 1285197418 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAUER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11496 N PORKYS RD | ||||||||
| Address2: | |||||||||
| City: | HAYWARD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 548436362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7156346895 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15657 W COUNTY HIGHWAY B | ||||||||
| Address2: | |||||||||
| City: | HAYWARD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 548432680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7155583528 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2019 | ||||||||
| LastUpdateDate: | 06/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174H00000X | Y | Other Service Providers | Health Educator |
No ID Information.