Healthcare Provider Details

I. General information

NPI: 1285625210
Provider Name (Legal Business Name): SCOTT ALAN BAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4175 N EUCLID AVE STE 10
BAY CITY MI
48706-2483
US

IV. Provider business mailing address

4175 N EUCLID AVE SUITE 10
BAY CITY MI
48706-2483
US

V. Phone/Fax

Practice location:
  • Phone: 989-684-4400
  • Fax: 989-684-0560
Mailing address:
  • Phone: 989-684-4400
  • Fax: 989-684-0560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number4301053017
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301053017
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: