KYOUNG SOO BAE M.D. NPI 1033114848

NPI Information

NPI: 1033114848
Provider Name: KYOUNG SOO BAE, M.D.
Classification: Radiology - 2085R0202X
Entity Type: Individual

Specialization: Diagnostic Radiology

Address:
36175 HARPER AVE
CLINTON TOWNSHIP, MI
ZIP 48035
Phone: (586) 741-3772
Get Directions

Kyoung Soo Bae, M.D. is a diagnostic radiology radiology in Clinton Township, MI. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. Kyoung Soo Bae, M.D. NPI is 1033114848. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

36175 HARPER AVE
CLINTON TOWNSHIP, MI
ZIP 48035-274
Phone: (586) 741-3772
Fax: (586) 741-4604

The enumeration date for this NPI number is 6/17/2005 and was last updated on 4/20/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2085R0202X	Radiology	Diagnostic Radiology	4301031350	MICHIGAN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	$$$$$$$$$	OTHER		WPS TRICARE FOR LIFE
2	0H26188	OTHER	MICHIGAN	BCBS PROVIDER NUMBER
3	0Q26008	OTHER	MICHIGAN	BCBS PROVIDER NUMBER
4	3558987	MEDICAID	MICHIGAN
5	B47411	MEDICARE UPIN	MICHIGAN
6	1006439	OTHER	MICHIGAN	MCLAREN HEALTH
7	110922	OTHER	MICHIGAN	GREAT LAKES HEALTH

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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