Basic Information
Provider Information
NPI: 1336296136
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BAUER
FirstName: TODD
MiddleName: MICHAEL
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 440100
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372440100
CountryCode: US
TelephoneNumber: 6153290570
FaxNumber: 6153207091
Practice Location
Address1: 300 20TH AVE N
Address2: SUITE 301
City: NASHVILLE
State: TN
PostalCode: 372032131
CountryCode: US
TelephoneNumber: 6153290570
FaxNumber: 6153207091
Other Information
ProviderEnumerationDate: 01/04/2007
LastUpdateDate: 07/27/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003X41849TNY Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

No ID Information.


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