Healthcare Provider Details

I. General information

NPI: 1366407413
Provider Name (Legal Business Name): DALE E BAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 W CLARK RD STE 401
YPSILANTI MI
48197-1120
US

IV. Provider business mailing address

3145 W CLARK RD STE 401
YPSILANTI MI
48197-1120
US

V. Phone/Fax

Practice location:
  • Phone: 734-528-5700
  • Fax: 734-528-5701
Mailing address:
  • Phone: 734-528-5700
  • Fax: 734-528-5701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number4301024290
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: