Provider Demographics
NPI:1902806326
Name:JERRY BAUER MD SC
Entity Type:Organization
Organization Name:JERRY BAUER MD SC
Other - Org Name:CENTER OF BRAIN AND SPINE SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LABBATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-698-1088
Mailing Address - Street 1:1875 W DEMPSTER
Mailing Address - Street 2:SUITE 605
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1168
Mailing Address - Country:US
Mailing Address - Phone:847-698-1088
Mailing Address - Fax:847-698-1087
Practice Address - Street 1:1875 W DEMPSTER
Practice Address - Street 2:SUITE 605
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1168
Practice Address - Country:US
Practice Address - Phone:847-698-1088
Practice Address - Fax:847-698-1087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6139800001Medicare NSC
247343Medicare UPIN