Basic Information
| Provider Information | |||||||||
| NPI: | 1801255815 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAUMGARTEN | ||||||||
| FirstName: | LEE | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 KILLEBREW DR STE 308 | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554251886 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6519996800 | ||||||||
| FaxNumber: | 6519996970 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 OSBORNE RD NE STE 120 | ||||||||
| Address2: | |||||||||
| City: | FRIDLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554322767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6519996800 | ||||||||
| FaxNumber: | 6519996970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2016 | ||||||||
| LastUpdateDate: | 07/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 68717 | MN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.