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General NPI Number Information
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NPI Number | 1407748809
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Entity Type | Organization
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Legal Business Name | BAKER BROOKLYN MD
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Dates
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Enumeration Date | 07/18/2025
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 30 N GOULD ST STE R44866
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City | SHERIDAN
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State | WY
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Zip | 82801-6317
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Country | US
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Telephone | 130-755-4795
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Fax |
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Provider Business Mailing Address
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Address Line | 30 N GOULD ST STE R44866
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City | SHERIDAN
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State | WY
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Zip | 82801-6317
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Country | US
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Telephone | 130-755-4795
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. MICHAEL IKECHI IKUNNAH
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Credential |
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Telephone | 307-554-7953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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