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General NPI Number Information
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NPI Number | 1417763269
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Entity Type | Organization
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Legal Business Name | APOTHEOSIS MEDICAL GROUP, PLLC
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 6523 MOSS OAK DR
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4221
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Country | US
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Telephone | 409-201-9655
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Fax | 210-200-8390
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Provider Business Mailing Address
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Address Line | PO BOX 40338
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City | SAN ANTONIO
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State | TX
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Zip | 78229-1338
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Country | US
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Telephone | 409-201-9654
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Fax | 210-200-8390
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN L BAEKE
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Credential | MD
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Telephone | 210-665-4199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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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 #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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