Individual
ANNALISE BAUERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
350 W NORTH AVE, ADDISON, IL 60101-4911
(630) 948-3989
Mailing address
350 W NORTH AVE, ADDISON, IL 60101-4911
(630) 948-3989
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
C0008716
MD
363A00000X
Physician Assistant
Primary
085.009330
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085.009330
PROFESSIONAL LICENSE
IL
01
—
C0008716
MEDICAL LICENSE
MD
Enumeration date
11/15/2022
Last updated
04/19/2024
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