MEDICARE: WILLIAM ANTHONY BAKER CSFA

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	246ZC0007X	Surgical Assistant	153167	KY

General Provider Information

NPI Number	:	1558119180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM ANTHONY BAKER CSFA

Provider Business Mailing Address
First Line	:	4613 ROXANN BLVD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-4072
Country	:	US
Telephone Number	:	859-494-5803
Fax Number	:

Provider Business Practice Location Address
First Line	:	4613 ROXANN BLVD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-4072
Country	:	US
Telephone Number	:	859-494-5803
Fax Number	:

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

Provider Enumeration Date	:	05/08/2024
Last Update Date	:	05/08/2024

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