Provider Demographics
NPI:1114662855
Name:BAUER, LAUREN ASHLEY (DO)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ASHLEY
Last Name:BAUER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15777 NORTHLINE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2354
Mailing Address - Country:US
Mailing Address - Phone:734-246-8100
Mailing Address - Fax:734-246-8621
Practice Address - Street 1:15777 NORTHLINE RD STE 202
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2354
Practice Address - Country:US
Practice Address - Phone:734-246-8100
Practice Address - Fax:734-246-8621
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101028690207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty