MEDICARE: TALIA BAKER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	036105167	IL
2	204F00000X	Transplant Surgery Physician	036105167	IL

General Provider Information

NPI Number	:	1255311577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TALIA BAKER M.D.

Provider Business Mailing Address
First Line	:	150 HARVESTER DRIVE
Second Line	:	SUITE 300
City	:	BURR RIDGE
State	:	IL
Zip	:	60527
Country	:	US
Telephone Number	:	773-702-1061
Fax Number	:	773-702-0000

Provider Business Practice Location Address
First Line	:	5841 S. MARYLAND AVENUE
Second Line	:	MC 5030
City	:	CHICAGO
State	:	IL
Zip	:	60637
Country	:	US
Telephone Number	:	773-702-9046
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	12/17/2021

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