Provider Demographics
NPI:1801255815
Name:BAUMGARTEN, LEE
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:
Last Name:BAUMGARTEN
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 1:2001 KILLEBREW DR STE 308
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1886
Mailing Address - Country:US
Mailing Address - Phone:651-999-6800
Mailing Address - Fax:651-999-6970
Practice Address - Street 1:500 OSBORNE RD NE STE 120
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2767
Practice Address - Country:US
Practice Address - Phone:651-999-6800
Practice Address - Fax:651-999-6970
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN68717208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty