Provider Demographics
NPI:1932334216
Name:BAUMGART, JAMES RICHARD (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RICHARD
Last Name:BAUMGART
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JAMIE
Other - Middle Name:RICHARD
Other - Last Name:BAUMGART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1836 SOUTH AVE
Mailing Address - Street 2:MAILSTOP C04-003
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5429
Mailing Address - Country:US
Mailing Address - Phone:608-775-8388
Mailing Address - Fax:608-775-4556
Practice Address - Street 1:1836 SOUTH AVE
Practice Address - Street 2:MAILSTOP C04-003
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-5429
Practice Address - Country:US
Practice Address - Phone:608-775-8388
Practice Address - Fax:608-775-4556
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI56063207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1932334216Medicaid
WI1932334216Medicaid
WI68086 1314Medicare PIN