Healthcare Provider Details

I. General information

NPI: 1760483911
Provider Name (Legal Business Name): MICHAEL CURTIS BAKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 N DONNELLY ST STE 103
MOUNT DORA FL
32757-2846
US

IV. Provider business mailing address

1502 N DONNELLY ST STE 103
MOUNT DORA FL
32757-2846
US

V. Phone/Fax

Practice location:
  • Phone: 352-383-0624
  • Fax: 352-383-0758
Mailing address:
  • Phone: 352-383-0624
  • Fax: 352-383-0758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 82068
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: