Individual
KYOUNG SOO BAE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301031350
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H26188
BCBS PROVIDER NUMBER
MI
01
—
0Q26008
BCBS PROVIDER NUMBER
MI
01
—
1006439
MCLAREN HEALTH
MI
01
—
110922
GREAT LAKES HEALTH
MI
05
—
3558987
—
MI
Enumeration date
06/17/2005
Last updated
04/20/2008
Update your record
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