Provider Demographics
NPI:1356641500
Name:KENNETH F BAUM MD PC
Entity Type:Organization
Organization Name:KENNETH F BAUM MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:F
Authorized Official - Last Name:BAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-638-4793
Mailing Address - Street 1:73 JASMINE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-5910
Mailing Address - Country:US
Mailing Address - Phone:303-638-4793
Mailing Address - Fax:303-377-2119
Practice Address - Street 1:73 JASMINE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-5910
Practice Address - Country:US
Practice Address - Phone:303-638-4793
Practice Address - Fax:303-377-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26007207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO=========Medicaid
CO=========Medicaid