Provider Demographics
NPI:1215955687
Name:BAELE, HENRY R (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:R
Last Name:BAELE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-3013
Practice Address - Fax:216-844-7716
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0484492086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0643266OtherAETNA
WV3810008724OtherWEST VIRGINIA MEDICAID
OH363333OtherWELLCARE
OHP00372943OtherRAILROAD MEDICARE
000000506532OtherANTHEM
OH000000206500OtherUNISON
OH0527693Medicaid
OH20023462OtherRAILROAD MEDICARE
OH740945OtherBUCKEYE
0643266OtherAETNA
OH363333OtherWELLCARE
OH0527693Medicaid