Healthcare Provider Details

I. General information

NPI: 1083630677
Provider Name (Legal Business Name): HUSEK H BAEK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 03/03/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OPC 371 BOX 39
APO AP
96271-9001
US

IV. Provider business mailing address

PSC 444 BOX 94
APO AP
96297-0001
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-1215
  • Fax:
Mailing address:
  • Phone: 821-073-5818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA77992
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: