Healthcare Provider Details

I. General information

NPI: 1235203076
Provider Name (Legal Business Name): WAYNE J. BAKER D.O.,S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OGDEN AVE
AURORA IL
60504-7222
US

IV. Provider business mailing address

2000 OGDEN AVE
AURORA IL
60504-7222
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-4810
  • Fax:
Mailing address:
  • Phone: 630-978-4810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: WAYNE JOSEPH BAKER
Title or Position: PRESIDENT
Credential: D.O.
Phone: 630-978-4810