Provider Demographics
NPI:1336590843
Name:BAATENBURG, LARA JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:LARA
Middle Name:JEAN
Last Name:BAATENBURG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:950 36TH ST SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-3587
Mailing Address - Country:US
Mailing Address - Phone:616-685-3300
Mailing Address - Fax:616-685-3303
Practice Address - Street 1:6741 FULTON ST E STE 200
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-9502
Practice Address - Country:US
Practice Address - Phone:616-290-1650
Practice Address - Fax:833-973-4117
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2025-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301109996207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine