Provider Demographics
NPI:1447295217
Name:BAUER, MISLEN STOL (MD)
Entity type:Individual
Prefix:
First Name:MISLEN
Middle Name:STOL
Last Name:BAUER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 SW 62ND AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3009
Mailing Address - Country:US
Mailing Address - Phone:305-663-8595
Mailing Address - Fax:305-669-6443
Practice Address - Street 1:3100 SW 62ND AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:305-663-8595
Practice Address - Fax:305-669-6443
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41628174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE30543Medicare UPIN