Healthcare Provider Details

I. General information

NPI: 1356641500
Provider Name (Legal Business Name): KENNETH F BAUM MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 10/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 JASMINE ST
DENVER CO
80220-5910
US

IV. Provider business mailing address

73 JASMINE ST
DENVER CO
80220-5910
US

V. Phone/Fax

Practice location:
  • Phone: 303-638-4793
  • Fax: 303-377-2119
Mailing address:
  • Phone: 303-638-4793
  • Fax: 303-377-2119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number26007
License Number StateCO

VIII. Authorized Official

Name: KENNETH F BAUM
Title or Position: OWNER
Credential: MD
Phone: 303-638-4793