Healthcare Provider Details

I. General information

NPI: 1538271267
Provider Name (Legal Business Name): KEITH R. BAKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1456 HUDSON RD
HILLSDALE MI
49242-8314
US

IV. Provider business mailing address

1456 HUDSON RD
HILLSDALE MI
49242-8314
US

V. Phone/Fax

Practice location:
  • Phone: 517-439-0200
  • Fax: 517-439-1050
Mailing address:
  • Phone: 517-439-0200
  • Fax: 517-439-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberKB041163
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberKB041163
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: