Healthcare Provider Details

I. General information

NPI: 1104403096
Provider Name (Legal Business Name): ZACHARY BAKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27100 CHARDON RD
RICHMOND HEIGHTS OH
44143-1116
US

IV. Provider business mailing address

27100 CHARDON RD
RICHMOND HEIGHTS OH
44143-1116
US

V. Phone/Fax

Practice location:
  • Phone: 440-585-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.155732
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: