MEDICARE: DR. ROBERT THOMAS BAKER III PSY.D.

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	103TC0700X	Clinical Psychologist	071006239	IL
2	103TC0700X	Clinical Psychologist	20041586A	IN

General Provider Information

NPI Number	:	1306280516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT THOMAS BAKER III PSY.D.

Provider Business Mailing Address
First Line	:	5315 N CLARK ST
Second Line	:	#319
City	:	CHICAGO
State	:	IL
Zip	:	60640-2290
Country	:	US
Telephone Number	:	847-331-4600
Fax Number	:

Provider Business Practice Location Address
First Line	:	5412 N CLARK ST
Second Line	:	#210
City	:	CHICAGO
State	:	IL
Zip	:	60640-1223
Country	:	US
Telephone Number	:	847-331-4600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2013
Last Update Date	:	04/18/2013

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