Healthcare Provider Details

I. General information

NPI: 1184679607
Provider Name (Legal Business Name): JOEL J BAUMGARTNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 3RD ST N
WAITE PARK MN
56387-1964
US

IV. Provider business mailing address

901 3RD ST N
WAITE PARK MN
56387-1964
US

V. Phone/Fax

Practice location:
  • Phone: 320-217-8480
  • Fax: 320-217-8490
Mailing address:
  • Phone: 320-217-8480
  • Fax: 320-217-8490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number43368
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: