Organization
TERRY SCOTT BAUL, M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY SCOTT BAUL D.O. (OWNER)
(313) 885-6833
Entity
Organization
Contact information
Practice address
17751 E WARREN AVE, DETROIT, MI 48224-1329
(313) 885-6833
(313) 885-1268
Mailing address
17751 E WARREN AVE, DETROIT, MI 48224-1329
(313) 885-6833
(313) 885-1268
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
4301042171
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0821263
BCBSM
MI
05
—
1624055
—
MI
Enumeration date
06/07/2012
Last updated
06/07/2012
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