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NPI Code Detail

MEDICARE: JAMES J BAEK M.D.

MEDICARE: JAMES J BAEK 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
12085R0202XDiagnostic Radiology Physician18837WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000023074OTHERWVBLUE CROSS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851393045
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES J BAEK M.D.
Provider Business Mailing Address
First Line : PO BOX 840
Second Line :
City : LIMA
State : OH
Zip : 45802-0840
Country : US
Telephone Number : 877-574-7116
Fax Number : 419-223-2726
Provider Business Practice Location Address
First Line : 4605 MACCORKLE AVE SW
Second Line :
City : SOUTH CHARLESTON
State : WV
Zip : 25309-1311
Country : US
Telephone Number : 304-766-3600
Fax Number : 304-343-4626
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 03/17/2018

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