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General NPI Number Information
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NPI Number | 1134184500
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Entity Type | Individual
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Provider Name | AMISHA M BAKER PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 02/15/2008
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Provider Practice Location Address
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Address Line | 1502 ELMHURST RD
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60007-6421
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Country | US
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Telephone | 847-228-0515
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Fax |
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Provider Business Mailing Address
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Address Line | 13 AEGINA DR
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City | TINLEY PARK
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State | IL
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Zip | 60477-4835
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Country | US
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Telephone | 847-228-0515
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | IL
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