MEDICARE: APOTHEOSIS MEDICAL GROUP, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician
3	208D00000X	General Practice Physician
4	208M00000X	Hospitalist Physician

General Provider Information

NPI Number	:	1417763269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APOTHEOSIS MEDICAL GROUP, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 40338
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-1338
Country	:	US
Telephone Number	:	409-201-9654
Fax Number	:	210-200-8390

Provider Business Practice Location Address
First Line	:	6523 MOSS OAK DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4221
Country	:	US
Telephone Number	:	409-201-9655
Fax Number	:	210-200-8390

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN L BAEKE
Credential	:	MD
Telephone Number	:	210-665-4199

Provider Enumeration Date	:	12/06/2024
Last Update Date	:	01/29/2026

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