Provider Demographics
NPI:1720087406
Name:BAER, MONIQUE (MD)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:BAER
Suffix:
Gender:F
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:PO BOX 3070
Mailing Address - Street 2:DUBUQUE
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52004-3070
Mailing Address - Country:US
Mailing Address - Phone:563-542-7935
Mailing Address - Fax:
Practice Address - Street 1:15398 STACIE CT
Practice Address - Street 2:DUBUQUE
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-9424
Practice Address - Country:US
Practice Address - Phone:563-542-7935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2012-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34186207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA38335OtherBLUE CROSS/BLUE SHIELD
IA2255489Medicaid
IA38335OtherBLUE CROSS/BLUE SHIELD
IAH53091Medicare UPIN