Healthcare Provider Details

I. General information

NPI: 1679672372
Provider Name (Legal Business Name): GEORGE H BAKER, JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 E GRAND RIVER AVE SUITE 109
LANSING MI
48912-4300
US

IV. Provider business mailing address

2909 E GRAND RIVER AVE SUITE 109
LANSING MI
48912-4300
US

V. Phone/Fax

Practice location:
  • Phone: 517-487-4480
  • Fax: 517-487-0193
Mailing address:
  • Phone: 517-487-4480
  • Fax: 517-487-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number4301028404
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: