Healthcare Provider Details

I. General information

NPI: 1558390435
Provider Name (Legal Business Name): BAKER FOOT SOLUTIONS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 N MADISON AVE
ANDERSON IN
46011-2130
US

IV. Provider business mailing address

PO BOX 330
FORTVILLE IN
46040-0330
US

V. Phone/Fax

Practice location:
  • Phone: 765-641-0001
  • Fax: 765-641-0003
Mailing address:
  • Phone: 317-863-2556
  • Fax: 317-203-0420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL J BAKER
Title or Position: PRESIDENT DIRECTOR
Credential: DPM
Phone: 317-863-2556