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Individual

DR. PETER BAUMGARTEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-5264
(309) 655-2000
Mailing address
111 OAKWOOD RD, EAST PEORIA, IL 61611-1853
(309) 740-4272

Taxonomy

Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
Primary
036079988
IL
2085N0904X
Nuclear Radiology Physician
4301501049
MI
2085R0202X
Diagnostic Radiology Physician
036079988
IL
2085R0202X
Diagnostic Radiology Physician
4301501049
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036079988
IL
01
202926
GROUP PTAN
IL
01
212545
GROUP PTAN
IL
01
4923631
BCBS ID
IL
Enumeration date
11/29/2006
Last updated
12/06/2023
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