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General NPI Number Information
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NPI Number | 1053589549
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Entity Type | Individual
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Provider Name | JEREMY MICHAEL BAUM M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/18/2008
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Last Update Date | 12/15/2010
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Provider Practice Location Address
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Address Line | 11111 S 84TH ST SUITE 2476
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City | PAPILLION
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State | NE
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Zip | 68046-4122
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Country | US
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Telephone | 402-339-8974
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Fax | 402-339-6741
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Provider Business Mailing Address
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Address Line | 10144 EDWARD ST
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City | LA VISTA
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State | NE
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Zip | 68128-2500
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Country | US
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Telephone | 402-614-3452
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 37694
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 245480-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 24581
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License Number State | NE
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