Provider Demographics
NPI:1093252074
Name:BAKER, SHAUN (PA-C)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2425 MILITARY STREET
Mailing Address - Street 2:BUILDING #2
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6692
Mailing Address - Country:US
Mailing Address - Phone:810-984-5700
Mailing Address - Fax:810-984-1886
Practice Address - Street 1:2425 MILITARY ST RM 2
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6692
Practice Address - Country:US
Practice Address - Phone:810-984-5700
Practice Address - Fax:810-984-1886
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008105363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant