Provider Demographics
NPI:1932119542
Name:BAUMAN, CHRIS GW (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:GW
Last Name:BAUMAN
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 1:2955 XENIUM LN N
Mailing Address - Street 2:SUITE 40
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-2666
Mailing Address - Country:US
Mailing Address - Phone:763-398-2203
Mailing Address - Fax:763-398-6533
Practice Address - Street 1:2955 XENIUM LN N
Practice Address - Street 2:SUITE 40
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2666
Practice Address - Country:US
Practice Address - Phone:763-398-2203
Practice Address - Fax:763-398-6533
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050370442085R0202X
NM2002-01442085R0202X
MN603652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207574906Medicaid
NM85359033Medicaid
MO937423832Medicare PIN
H63323Medicare UPIN
NM85359033Medicaid
MO937425276Medicare PIN
NMNM302694Medicare PIN
MO937420365Medicare PIN
MOCH0689Medicare PIN