Provider Demographics
NPI:1376208413
Name:BAUM, STEVE
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:BAUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 GARWOOD DRIVE
Mailing Address - Street 2:GARWOOD
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853
Mailing Address - Country:US
Mailing Address - Phone:314-265-3503
Mailing Address - Fax:
Practice Address - Street 1:1314 GARWOOD DRIVE
Practice Address - Street 2:GARWOOD
Practice Address - City:MAHOMET
Practice Address - State:IL
Practice Address - Zip Code:61853
Practice Address - Country:US
Practice Address - Phone:314-265-3503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach