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General NPI Number Information
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NPI Number | 1518628460
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Entity Type | Individual
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Provider Name | ALYSSA BAKER
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Gender | Female
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Dates
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Enumeration Date | 01/03/2022
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Last Update Date | 01/30/2026
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Provider Practice Location Address
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Address Line | 17950 WOODWARD AVE
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City | DETROIT
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State | MI
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Zip | 48203-2260
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Country | US
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Telephone | 313-401-0929
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Fax | 313-401-0927
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Provider Business Mailing Address
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Address Line | 3000 ARLINGTON AVE # MS 1027
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City | TOLEDO
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State | OH
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Zip | 43614-2595
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Country | US
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Telephone | 419-530-5408
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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 | 5601011688
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License Number State | MI
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