Provider Demographics
NPI:1033110796
Name:BAER, RICHARD KENYTH (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KENYTH
Last Name:BAER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 W CONCORD LN
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5742
Mailing Address - Country:US
Mailing Address - Phone:312-335-3881
Mailing Address - Fax:312-335-3884
Practice Address - Street 1:241 W CONCORD LN
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5742
Practice Address - Country:US
Practice Address - Phone:312-335-3881
Practice Address - Fax:312-335-3884
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
D14836Medicare UPIN
566460Medicare PIN