MEDICARE: MR. MIKE - BAKER PA-C

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	363A00000X	Physician Assistant	PA15215	CA

General Provider Information

NPI Number	:	1588729115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MIKE - BAKER PA-C

Provider Business Mailing Address
First Line	:	948 DESMET LANE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125
Country	:	US
Telephone Number	:	408-203-9066
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 KIELY BLVD BUILDING D
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-5386
Country	:	US
Telephone Number	:	408-236-4251
Fax Number	:

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

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	07/08/2007

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