Provider Demographics
NPI:1063498145
Name:BAUM, CRAIG STEVE (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:STEVE
Last Name:BAUM
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 1:3333 BARDSTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218
Mailing Address - Country:US
Mailing Address - Phone:502-452-6337
Mailing Address - Fax:502-458-5327
Practice Address - Street 1:3333 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-4613
Practice Address - Country:US
Practice Address - Phone:502-452-6337
Practice Address - Fax:502-452-6337
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37874208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200463370Medicaid
KY64054224Medicaid
KY64054224Medicaid
H65565Medicare UPIN