MEDICARE: BAKER MEDICAL CORPORATION, LTD

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	174400000X	Specialist	017057	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0856041000	OTHER	LA	BLUE CROSS

General Provider Information

NPI Number	:	1235132036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAKER MEDICAL CORPORATION, LTD

Provider Business Mailing Address
First Line	:	3034 RAY WEILAND DR
Second Line	:
City	:	BAKER
State	:	LA
Zip	:	70714-3252
Country	:	US
Telephone Number	:	225-775-8500
Fax Number	:	225-775-0289

Provider Business Practice Location Address
First Line	:	3034 RAY WEILAND DR
Second Line	:
City	:	BAKER
State	:	LA
Zip	:	70714-3252
Country	:	US
Telephone Number	:	225-775-8500
Fax Number	:	225-775-0289

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RODOLFO M MANALAC
Credential	:	MD
Telephone Number	:	225-775-8500

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	05/16/2008

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Directions to “BAKER MEDICAL CORPORATION, LTD ” Practice Location

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