Healthcare Provider Details

I. General information

NPI: 1912979626
Provider Name (Legal Business Name): SUSAN BAKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 09/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NW 95TH ST
MIAMI FL
33150-2038
US

IV. Provider business mailing address

PO BOX 5040
HIALEAH FL
33014-1040
US

V. Phone/Fax

Practice location:
  • Phone: 305-835-4725
  • Fax:
Mailing address:
  • Phone: 305-503-6320
  • Fax: 305-503-6329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberME46836
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberME46836
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME46836
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: