Basic Information
| Provider Information | |||||||||
| NPI: | 1043240575 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAUMANN | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4500 BISCAYNE BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055325552 | ||||||||
| FaxNumber: | 3055345224 | ||||||||
| Practice Location | |||||||||
| Address1: | 4500 BISCAYNE BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055325552 | ||||||||
| FaxNumber: | 3055345224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 05/01/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | ME72961 | FL | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 2528801-00 | 05 | FL | MEDICAID |