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NPI Code Detail

MEDICARE: TERRANCE PATRICK BAKER M.D.

MEDICARE: TERRANCE PATRICK 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
1207Q00000XFamily Medicine PhysicianIL

General Provider Information

NPI Number : 1750403572
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRANCE PATRICK BAKER M.D.
Provider Business Mailing Address
First Line : 827 HIGHLAND AVE
Second Line :
City : OAK PARK
State : IL
Zip : 60304-1528
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2800 S CALIFORNIA AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60608-5107
Country : US
Telephone Number : 773-869-3822
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2007
Last Update Date : 07/08/2007

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