Provider Demographics
NPI:1316075435
Name:BAUKUS, ERWIN J (PHD)
Entity type:Individual
Prefix:DR
First Name:ERWIN
Middle Name:J
Last Name:BAUKUS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-0229
Mailing Address - Country:US
Mailing Address - Phone:815-939-4232
Mailing Address - Fax:815-939-4978
Practice Address - Street 1:22 HERITAGE DRIVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2503
Practice Address - Country:US
Practice Address - Phone:815-939-4232
Practice Address - Fax:815-939-4978
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004607679OtherBCBS
62413OtherCIGNA