Healthcare Provider Details

I. General information

NPI: 1871612986
Provider Name (Legal Business Name): CLAUDE THOMAS BAKER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6845 LEE AVE N
BROOKLYN CENTER MN
55429-1717
US

IV. Provider business mailing address

10115 CHESTNUT CIR N
BROOKLYN PARK MN
55443-1862
US

V. Phone/Fax

Practice location:
  • Phone: 763-503-4400
  • Fax:
Mailing address:
  • Phone: 763-424-5988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number9886
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: