Provider Demographics
NPI:1851414981
Name:BAUMGARDNER, MAXEN LANE (DO)
Entity Type:Individual
Prefix:DR
First Name:MAXEN
Middle Name:LANE
Last Name:BAUMGARDNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2696 HALYARD CT
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911
Mailing Address - Country:US
Mailing Address - Phone:517-242-7317
Mailing Address - Fax:
Practice Address - Street 1:1215 E. MICHIGAN AVE
Practice Address - Street 2:SPARROW HOSPITAL, ATTN DR BAUMGARDNER - ER
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912
Practice Address - Country:US
Practice Address - Phone:517-364-2356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016190207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00631550Medicare PIN
MIC37626070Medicare PIN