Provider Demographics
NPI:1235124488
Name:BAUMGART, JOSEPH R (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:BAUMGART
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 1:374 KINGSBURY DR
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-8283
Mailing Address - Country:US
Mailing Address - Phone:815-758-8621
Mailing Address - Fax:815-758-5838
Practice Address - Street 1:374 KINGSBURY DR
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-8283
Practice Address - Country:US
Practice Address - Phone:815-758-8621
Practice Address - Fax:815-758-5838
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-066682207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036066682Medicaid
IL713060Medicare PIN
IL036066682Medicaid