Provider Demographics
NPI:1972589919
Name:BAIER, MAX A (NP)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:A
Last Name:BAIER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-1400
Mailing Address - Country:US
Mailing Address - Phone:618-932-3937
Mailing Address - Fax:
Practice Address - Street 1:2553 KEN GRAY BLVD
Practice Address - Street 2:
Practice Address - City:WEST FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:62896-4174
Practice Address - Country:US
Practice Address - Phone:618-932-3937
Practice Address - Fax:618-932-2734
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004084363L00000X
IL085-000253363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical