Provider Demographics
NPI:1053346726
Name:BAUER, RICHARD M (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:BAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:M
Other - Last Name:BAUER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:104 OAKMONT RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4114
Mailing Address - Country:US
Mailing Address - Phone:847-471-3828
Mailing Address - Fax:847-432-6168
Practice Address - Street 1:104 OAKMONT RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-4114
Practice Address - Country:US
Practice Address - Phone:847-471-3828
Practice Address - Fax:847-432-6168
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360547552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL300118676OtherRR MEDICARE
IL01618831OtherBCBS PROVIDER NUMBER
IL036054755Medicaid
IL300118676OtherRR MEDICARE
IL01618831OtherBCBS PROVIDER NUMBER