Healthcare Provider Details

I. General information

NPI: 1891883120
Provider Name (Legal Business Name): MICHAEL P BAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 N PINE
PITTSBURG KS
66762
US

IV. Provider business mailing address

107 N PINE PO BOX 1628
PITTSBURG KS
66762
US

V. Phone/Fax

Practice location:
  • Phone: 620-232-7500
  • Fax: 620-231-7501
Mailing address:
  • Phone: 620-232-7500
  • Fax: 620-231-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number04-24544
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: