Provider Demographics
NPI:1346336658
Name:BAUMGARTNER, RAYMOND A (DPM)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:A
Last Name:BAUMGARTNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E. COLUMBINE LANE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074
Mailing Address - Country:US
Mailing Address - Phone:317-872-8042
Mailing Address - Fax:317-872-8044
Practice Address - Street 1:8240 NAAB RD
Practice Address - Street 2:SUITE 360
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260
Practice Address - Country:US
Practice Address - Phone:317-872-8042
Practice Address - Fax:317-872-8044
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000742A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000091401OtherANTHEM BCBS
IN480032599OtherMEDICARE RAILROAD
IN100119540Medicaid
INU28556Medicare UPIN
INP01050073Medicare PIN
IN000000091401OtherANTHEM BCBS
IN261270Medicare PIN
IN4440520001Medicare NSC