Provider Demographics
NPI:1194349969
Name:BAUMGARTNER, KATHRYN ELIZABETH (DO)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:BAUMGARTNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2446 JOLLY RD STE B
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3514
Mailing Address - Country:US
Mailing Address - Phone:517-253-5530
Mailing Address - Fax:517-253-5535
Practice Address - Street 1:2446 JOLLY RD STE B
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3514
Practice Address - Country:US
Practice Address - Phone:517-253-5530
Practice Address - Fax:517-253-5535
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101026877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine