Provider Demographics
NPI:1922094325
Name:BAUM, MICHAEL RAYMOND (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RAYMOND
Last Name:BAUM
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 1:100 HOSPITAL DR
Mailing Address - Street 2:STE 103
Mailing Address - City:BARNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43713-1098
Mailing Address - Country:US
Mailing Address - Phone:740-425-5190
Mailing Address - Fax:740-425-5197
Practice Address - Street 1:100 HOSPITAL DR
Practice Address - Street 2:STE 103
Practice Address - City:BARNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43713-1098
Practice Address - Country:US
Practice Address - Phone:740-425-5190
Practice Address - Fax:740-425-5197
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH35043893B208600000X
WV19816208600000X
OH35-04-3893B208D00000X
OH35043893207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0512298Medicaid
OH0549674OtherMEDICARE ID
OH0512298Medicaid