Healthcare Provider Details

I. General information

NPI: 1225667645
Provider Name (Legal Business Name): ATLEE T BAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7836 W JEFFERSON BLVD STE 101
FORT WAYNE IN
46804-4178
US

IV. Provider business mailing address

120 W 22ND ST STE 200
OAK BROOK IL
60523-1563
US

V. Phone/Fax

Practice location:
  • Phone: 260-494-3484
  • Fax: 260-969-0188
Mailing address:
  • Phone: 630-573-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number4301513465
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: