Basic Information
| Provider Information | |||||||||
| NPI: | 1740256064 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAHNTGE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | FREDERICK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20525 CENTER RIDGE RD | ||||||||
| Address2: | STE 220 | ||||||||
| City: | ROCKY RIVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408955056 | ||||||||
| FaxNumber: | 4403332935 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 METROHEALTH DR | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441091900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2167783958 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 09/23/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 35048477B | OH | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 11046868 | 01 | CAQH | OTHER | CA4511 | 01 | RR MEDICARE GROUP | OTHER | D368301 | 01 | GROUP IND DIAGNOSTICS MED | OTHER | 9273172 | 01 | GROUP MEDICARE | OTHER | 0119204 | 01 | GROUP MEDICAID | OTHER | 0587931 | 05 | OH | MEDICAID | 1780634279 | 01 | GROUPNPI | OTHER | 4326122 | 01 | AETNA | OTHER | CA4511 | 01 | GROUP RR MEDICARE | OTHER | 000000276513 | 01 | ANTHEM | OTHER | 0501231 | 01 | UNITED HEALTHCARE | OTHER | 341783789031 | 01 | CARESOURCE | OTHER | C78477 | 01 | SUMMACARE APEX | OTHER | 3610861 | 01 | GROUP ASC MEDICARE | OTHER | 103647 | 01 | KAISER | OTHER | 130026262 | 01 | RR MEDICARE INDIVIDUAL | OTHER |