Healthcare Provider Details

I. General information

NPI: 1992736474
Provider Name (Legal Business Name): BAKER FOOT SOLUTIONS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N WABASH AVE STE 460A
MARION IN
46952-2685
US

IV. Provider business mailing address

PO BOX 330
FORTVILLE IN
46040-0330
US

V. Phone/Fax

Practice location:
  • Phone: 765-664-1413
  • Fax: 765-664-2780
Mailing address:
  • Phone: 317-863-2556
  • Fax: 317-203-0420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07000796A
License Number StateIN

VIII. Authorized Official

Name: DR. MICHAEL J BAKER
Title or Position: PRESIDENT/DIRECTOR
Credential: D.P.M.
Phone: 317-863-2556