Healthcare Provider Details

I. General information

NPI: 1891786950
Provider Name (Legal Business Name): SHEILA DENISE BAKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 LINCOLN AVE EASTERN ILLINOIS UNIVERSITY
CHARLESTON IL
61920-3011
US

IV. Provider business mailing address

600 LINCOLN AVE EASTERN ILLINOIS UNIVERSITY
CHARLESTON IL
61920-3011
US

V. Phone/Fax

Practice location:
  • Phone: 217-581-3015
  • Fax: 217-581-3899
Mailing address:
  • Phone: 217-581-3015
  • Fax: 217-581-3899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: