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General NPI Number Information
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NPI Number | 1134028640
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Entity Type | Organization
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Legal Business Name | BAKER STREET HEALTH PC
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Dates
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Enumeration Date | 11/02/2026
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Last Update Date | 11/02/2026
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Provider Practice Location Address
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Address Line | 11304 DISTINCTIVE DR
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City | ORLAND PARK
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State | IL
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Zip | 60467-9459
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Country | US
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Telephone | 708-529-8230
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Fax | 205-606-8230
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Provider Business Mailing Address
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Address Line | 4850 N BROADWAY ST
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City | CHICAGO
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State | IL
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Zip | 60640-0038
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Country | US
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Telephone | 708-529-8230
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Fax | 205-606-8230
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Authorized Official
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Title or Position | OWNER
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Name | DAVID TYSON
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Credential | MD
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Telephone | 804-986-4140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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