MEDICARE: RONALD L BAKER M.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	207V00000X	Obstetrics & Gynecology Physician	01031122A	IN

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	000000595611	OTHER	IN	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952300329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD L BAKER M.D.

Provider Business Mailing Address
First Line	:	1234 E DUPONT RD
Second Line	:	SUITE 1
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1545
Country	:	US
Telephone Number	:	260-373-9700
Fax Number	:	260-373-9740

Provider Business Practice Location Address
First Line	:	11123 PARKVIEW PLAZA DR
Second Line	:	SUITE 101
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1707
Country	:	US
Telephone Number	:	260-422-7455
Fax Number	:	260-424-9356

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	03/25/2013

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