Healthcare Provider Details

I. General information

NPI: 1316913122
Provider Name (Legal Business Name): MICHAEL ROBERT BAKER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLANCHFIELD ARMY COMMUNITY HOSPITAL 650 JOEL DRIVE
FT. CAMPBELL KY
42223-5349
US

IV. Provider business mailing address

BLANCHFIELD ARMY COMMUNITY HOSPITAL 650 JOEL DRIVE
FT. CAMPBELL KY
42223-5349
US

V. Phone/Fax

Practice location:
  • Phone: 270-798-8372
  • Fax: 270-956-0180
Mailing address:
  • Phone: 270-798-8372
  • Fax: 270-956-0180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number005782
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: