Healthcare Provider Details

I. General information

NPI: 1881634467
Provider Name (Legal Business Name): CHERYL L BAKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 LORETTO RD
LEBANON KY
40033-1300
US

IV. Provider business mailing address

PO BOX 182255
COLUMBUS OH
43218-2255
US

V. Phone/Fax

Practice location:
  • Phone: 270-692-5267
  • Fax:
Mailing address:
  • Phone: 513-852-2442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number39542
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: