Provider Demographics
NPI:1982604054
Name:BAUMGARTNER, CRAIG ALLEN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:ALLEN
Last Name:BAUMGARTNER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 LINDENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2653
Mailing Address - Country:US
Mailing Address - Phone:847-904-7168
Mailing Address - Fax:
Practice Address - Street 1:1 GOLFVIEW RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-1210
Practice Address - Country:US
Practice Address - Phone:847-726-4444
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR17264Medicare UPIN
IL567410Medicare ID - Type UnspecifiedPROVIDER NUMBER