Healthcare Provider Details

I. General information

NPI: 1104602663
Provider Name (Legal Business Name): LUKE PATRICK BAKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6080 S 108TH ST STE 2
HALES CORNERS WI
53130-2557
US

IV. Provider business mailing address

6080 S 108TH ST STE 2
HALES CORNERS WI
53130-2557
US

V. Phone/Fax

Practice location:
  • Phone: 224-406-0559
  • Fax:
Mailing address:
  • Phone: 224-406-0559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0-23-14719
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: