Healthcare Provider Details

I. General information

NPI: 1992167902
Provider Name (Legal Business Name): ANDREW BAKER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 GRANT LINE RD
NEW ALBANY IN
47150-2492
US

IV. Provider business mailing address

1234 HUFFMAN MILL ROAD
BURLINGTON NC
27215-8700
US

V. Phone/Fax

Practice location:
  • Phone: 812-725-7542
  • Fax:
Mailing address:
  • Phone: 502-804-4811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number246411
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07001304A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number729
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: