Provider Demographics
NPI:1467820985
Name:FRANK R. BAUM, MD, INC.
Entity Type:Organization
Organization Name:FRANK R. BAUM, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-871-7116
Mailing Address - Street 1:200 KALEPA PL
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2471
Mailing Address - Country:US
Mailing Address - Phone:808-871-7116
Mailing Address - Fax:
Practice Address - Street 1:200 KALEPA PL
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2471
Practice Address - Country:US
Practice Address - Phone:808-871-7116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-52602080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01860001Medicaid
HI01860001Medicaid