Individual
LUANN BAUER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
63 N WILLIAMS ST, CRYSTAL LAKE, IL 60014-4443
(815) 356-9900
Mailing address
63 N WILLIAMS ST, CRYSTAL LAKE, IL 60014-4443
(815) 356-9900
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
20-1975060
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20-1975060
TAX ID #
IL
Enumeration date
11/02/2018
Last updated
11/02/2018
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