Healthcare Provider Details

I. General information

NPI: 1114459518
Provider Name (Legal Business Name): HEATHER KATHRYN BAUMANN-LANEVE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 MEDICAL DISTRICT DR
DALLAS TX
75235-7701
US

IV. Provider business mailing address

3100 CARLISLE ST APT 9105
DALLAS TX
75204-1553
US

V. Phone/Fax

Practice location:
  • Phone: 469-488-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberS4921
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: