Provider Demographics
NPI:1316923642
Name:BAUMANN, JOHN C (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:BAUMANN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 WEST RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2399
Mailing Address - Country:US
Mailing Address - Phone:734-675-1200
Mailing Address - Fax:734-675-5547
Practice Address - Street 1:3231 WEST RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2399
Practice Address - Country:US
Practice Address - Phone:734-675-1200
Practice Address - Fax:734-675-5547
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI006627208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1378470Medicaid
MI1378470Medicaid
MI5821633Medicare ID - Type Unspecified