Healthcare Provider Details

I. General information

NPI: 1841499183
Provider Name (Legal Business Name): ROBERT S BAKER MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 RT 83 STE #106
LONG GROVE IL
60047-5083
US

IV. Provider business mailing address

4160 RT 83 STE #106
LONG GROVE IL
60047-5083
US

V. Phone/Fax

Practice location:
  • Phone: 847-955-1139
  • Fax: 815-955-1139
Mailing address:
  • Phone: 847-955-1139
  • Fax: 815-955-1139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number036058454
License Number StateIL

VIII. Authorized Official

Name: FAYE FIELDS
Title or Position: BILLING MANAGER
Credential:
Phone: 815-356-1559