Healthcare Provider Details

I. General information

NPI: 1255311577
Provider Name (Legal Business Name): TALIA BAKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S. MARYLAND AVENUE MC 5030
CHICAGO IL
60637
US

IV. Provider business mailing address

150 HARVESTER DRIVE SUITE 300
BURR RIDGE IL
60527
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-9046
  • Fax:
Mailing address:
  • Phone: 773-702-1061
  • Fax: 773-702-0000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036105167
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number036105167
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: