Provider Demographics
NPI:1386088508
Name:BAUER, BROOKE (MD)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:GINTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5200 COMMERCE CROSSINGS DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2182
Mailing Address - Country:US
Mailing Address - Phone:502-253-4900
Mailing Address - Fax:
Practice Address - Street 1:2400 EASTPOINT PKWY STE 410
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4154
Practice Address - Country:US
Practice Address - Phone:502-253-6625
Practice Address - Fax:502-253-6629
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR1704207LP2900X
KY49059207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100329620Medicaid