Healthcare Provider Details

I. General information

NPI: 1164624508
Provider Name (Legal Business Name): LYSLE BAUMGARTNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RICHARD BAUMGARTNER MD

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 KENNY RD
UPPER ARLINGTON OH
43221-1500
US

IV. Provider business mailing address

3400 KENNY RD
UPPER ARLINGTON OH
43221-1500
US

V. Phone/Fax

Practice location:
  • Phone: 614-457-8158
  • Fax: 614-457-9155
Mailing address:
  • Phone: 614-457-8158
  • Fax: 614-457-9155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number35-022954
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: