MEDICARE: MR. CRAIG ALLEN BAUMGARTNER PA-C

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	363A00000X	Physician Assistant		IL

General Provider Information

NPI Number	:	1982604054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CRAIG ALLEN BAUMGARTNER PA-C

Provider Business Mailing Address
First Line	:	3212 LINDENWOOD LN
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60025-2653
Country	:	US
Telephone Number	:	847-904-7168
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 GOLFVIEW RD
Second Line	:	SUITE 101
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-1210
Country	:	US
Telephone Number	:	847-726-4444
Fax Number	:

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	07/08/2007

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