Provider Demographics
NPI:1093936429
Name:BAKER, MATHUE MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MATHUE
Middle Name:MICHAEL
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6607
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-0607
Mailing Address - Country:US
Mailing Address - Phone:402-483-3333
Mailing Address - Fax:402-483-3297
Practice Address - Street 1:1600 S 48TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1275
Practice Address - Country:US
Practice Address - Phone:402-483-3333
Practice Address - Fax:402-483-3297
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23935207R00000X, 207RA0000X, 207RC0000X, 207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1093936429Medicaid
NE23935OtherMEDICAL LICENSE
NE47084496100Medicaid
NE099106009Medicare PIN