MEDICARE: CRAIG STEVE BAUM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	37874	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063498145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG STEVE BAUM MD

Provider Business Mailing Address
First Line	:	3333 BARDSTOWN ROAD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218
Country	:	US
Telephone Number	:	502-452-6337
Fax Number	:	502-458-5327

Provider Business Practice Location Address
First Line	:	3333 BARDSTOWN RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-4613
Country	:	US
Telephone Number	:	502-452-6337
Fax Number	:	502-452-6337

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	09/12/2013

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