Healthcare Provider Details

I. General information

NPI: 1396025581
Provider Name (Legal Business Name): MICHAEL L BAKER DO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MEMORIAL AVE SUITE B
WASHINGTON IN
47501-3153
US

IV. Provider business mailing address

1401 MEMORIAL AVE SUITE B
WASHINGTON IN
47501-3153
US

V. Phone/Fax

Practice location:
  • Phone: 812-254-2400
  • Fax: 812-254-3191
Mailing address:
  • Phone: 812-254-2400
  • Fax: 812-254-3191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number02002933A
License Number StateIN

VIII. Authorized Official

Name: MICHAEL L BAKER
Title or Position: SINGLE MEMBER/OWNER
Credential: D.O.
Phone: 812-254-2400