Individual
DR. MICHAEL BAUMGARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
6847 N CHESTNUT ST, RAVENNA, OH 44266-3929
(330) 297-0811
Mailing address
5354 NEWTON FALLS RD, RAVENNA, OH 44266-7701
(330) 296-0703
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
34-005587
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000244880
ANTHEM PROVIDER NUMBER
OH
Enumeration date
08/10/2006
Last updated
07/08/2007
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