Healthcare Provider Details

I. General information

NPI: 1326233909
Provider Name (Legal Business Name): MICHAEL R BAKER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 PARKSIDE DRIVE STE 200
COLORADO SPRINGS CO
80910
US

IV. Provider business mailing address

215 PARKSIDE DRIVE STE #200
COLORADO SPRINGS CO
80910
US

V. Phone/Fax

Practice location:
  • Phone: 719-475-9613
  • Fax: 719-475-9539
Mailing address:
  • Phone: 719-475-9613
  • Fax: 719-475-9539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number38892
License Number StateCO

VIII. Authorized Official

Name: MICHAEL R BAKER
Title or Position: OWNER
Credential: MD
Phone: 719-475-9613