Provider Demographics
NPI:1265400717
Name:BAUER, AUDREY G (MD)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:G
Last Name:BAUER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AUDREY
Other - Middle Name:G
Other - Last Name:BOLANOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5251 DTC PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2731
Mailing Address - Country:US
Mailing Address - Phone:303-779-9633
Mailing Address - Fax:303-221-0981
Practice Address - Street 1:5251 DTC PKWY STE 200
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2731
Practice Address - Country:US
Practice Address - Phone:303-779-9633
Practice Address - Fax:303-221-0981
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA166726208600000X
FL145718208600000X
CO0053119208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19730381Medicaid
CO024177OtherKAISER COMMERCIAL NUMBER
CO19730381Medicaid