Healthcare Provider Details

I. General information

NPI: 1578764254
Provider Name (Legal Business Name): HERBERT L BAKER MD PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20905 GREENFIELD RD SUITE 701
SOUTHFIELD MI
48075-5360
US

IV. Provider business mailing address

PO BOX 2220
SOUTHFIELD MI
48037-2220
US

V. Phone/Fax

Practice location:
  • Phone: 248-557-2900
  • Fax: 248-557-2903
Mailing address:
  • Phone: 248-557-2900
  • Fax: 248-557-2903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: HERBERT BAKER
Title or Position: PROVIDER
Credential: MD
Phone: 313-342-9820