MEDICARE: MICHAEL E. BAKER ATC

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	2255A2300X	Athletic Trainer	AT133	OK

General Provider Information

NPI Number	:	1578827804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL E. BAKER ATC

Provider Business Mailing Address
First Line	:	1609 N STRONG BLVD
Second Line	:
City	:	MCALESTER
State	:	OK
Zip	:	74501-3839
Country	:	US
Telephone Number	:	918-429-7701
Fax Number	:

Provider Business Practice Location Address
First Line	:	1609 N STRONG BLVD
Second Line	:
City	:	MCALESTER
State	:	OK
Zip	:	74501-3839
Country	:	US
Telephone Number	:	918-426-1322
Fax Number	:

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

Provider Enumeration Date	:	07/02/2012
Last Update Date	:	07/02/2012

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