Provider Demographics
NPI:1053121269
Name:BAUMANN, NICK
Entity type:Individual
Prefix:
First Name:NICK
Middle Name:
Last Name:BAUMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 GARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1705
Mailing Address - Country:US
Mailing Address - Phone:317-274-8157
Mailing Address - Fax:
Practice Address - Street 1:2745 GARRISON AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1705
Practice Address - Country:US
Practice Address - Phone:847-648-1566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program