MEDICARE: KEVIN ANTHONY BAUMER M.D.

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	207X00000X	Orthopaedic Surgery Physician	036090101	IL

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	:	1891799565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN ANTHONY BAUMER M.D.

Provider Business Mailing Address
First Line	:	4700 MEMORIAL DR
Second Line	:	STE 340
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-5373
Country	:	US
Telephone Number	:	618-234-9884
Fax Number	:	618-235-9020

Provider Business Practice Location Address
First Line	:	4700 MEMORIAL DR
Second Line	:	STE 340
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-5373
Country	:	US
Telephone Number	:	618-234-9884
Fax Number	:	618-235-9020

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	02/05/2021

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