Provider Demographics
NPI:1104934132
Name:BAUER, MICHELE LEE (MD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:LEE
Last Name:BAUER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:LEE
Other - Last Name:BACHHUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2503 N HILLCREST PKWY
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2569
Mailing Address - Country:US
Mailing Address - Phone:715-852-5721
Mailing Address - Fax:
Practice Address - Street 1:2503 N HILLCREST PKWY
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2569
Practice Address - Country:US
Practice Address - Phone:715-852-5721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33854207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32032500Medicaid
F83643Medicare UPIN
WI46272200Medicare ID - Type Unspecified