Healthcare Provider Details

I. General information

NPI: 1205854999
Provider Name (Legal Business Name): WILLIAM VANCE BAKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: W VANCE BAKER M.D.

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 S. 70TH ST. TLS
MILWAUKEE WI
53214
US

IV. Provider business mailing address

1040 S. 70TH ST. TLS
MILWAUKEE WI
53214
US

V. Phone/Fax

Practice location:
  • Phone: 414-476-9675
  • Fax: 414-615-0627
Mailing address:
  • Phone: 414-476-9675
  • Fax: 414-615-0627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number23918020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: