MEDICARE: THOMAS BAKER CRNA

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	367500000X	Certified Registered Nurse Anesthetist	4704147166	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TB147166	OTHER	MI	BLUE CROSS OF MI

General Provider Information

NPI Number	:	1346216744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS BAKER CRNA

Provider Business Mailing Address
First Line	:	PO BOX 67000
Second Line	:	DEPT 203401
City	:	DETROIT
State	:	MI
Zip	:	48267-0002
Country	:	US
Telephone Number	:	952-442-9770
Fax Number	:

Provider Business Practice Location Address
First Line	:	6071 W OUTER DR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-2624
Country	:	US
Telephone Number	:	952-442-9770
Fax Number	:

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

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	07/08/2007

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Directions to “ THOMAS BAKER CRNA” Practice Location

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