Individual
ELIZABETH BAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3860 W OGDEN AVE, CHICAGO, IL 60623-2460
(872) 588-3000
Mailing address
3860 W OGDEN AVE, CHICAGO, IL 60623-2460
(872) 588-3000
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085003983
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085003983
IL STATE LICENSE NUMBER
IL
01
—
1096486
SPECIALTY BOARDS
IL
01
—
385002761
ILLINOIS CONTROLLED SUBSTANCE NUMBER
IL
Enumeration date
03/01/2011
Last updated
03/07/2023
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