Healthcare Provider Details

I. General information

NPI: 1730826272
Provider Name (Legal Business Name): TESSA LUCY EVELYN BAUM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 776084
CHICAGO IL
60677-6084
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 636-240-0130
  • Fax: 636-240-6822
Mailing address:
  • Phone: 636-240-0130
  • Fax: 636-240-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2022018013
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: