Basic Information
| Provider Information | |||||||||
| NPI: | 1306801964 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAUMANN | ||||||||
| FirstName: | HERMAN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BAUMANN | ||||||||
| OtherFirstName: | HAL | ||||||||
| OtherMiddleName: | A | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 1930 BISHOP LN | ||||||||
| Address2: | STE 1600 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402181929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022725044 | ||||||||
| FaxNumber: | 5022725121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 08/29/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 23255 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 01033465A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110138275 | 01 | IN | RAILROAD MEDICARE | OTHER | 00000050932 | 01 | ANTHEM - NCMA | OTHER | 100086530 | 05 | IN | MEDICAID | P00357999 | 01 | KY | RAILROAD MEDICARE | OTHER | 000000724438 | 01 | KY | ANTHEM - NHC | OTHER | 127314 | 01 | KY | SIHO - NHC | OTHER | 64232556 | 05 | KY | MEDICAID | 004187 | 01 | SIHO - NCMA | OTHER | 50035904 | 01 | KY | PASSPORT - NHC | OTHER |