Provider Demographics
NPI:1114011293
Name:BAKER, STEPHAN (MD)
Entity Type:Individual
Prefix:MR
First Name:STEPHAN
Middle Name:
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 1:4425 PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146
Mailing Address - Country:US
Mailing Address - Phone:305-381-8837
Mailing Address - Fax:305-444-8556
Practice Address - Street 1:4425 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146
Practice Address - Country:US
Practice Address - Phone:305-381-8837
Practice Address - Fax:305-444-8556
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53349208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F45741Medicare UPIN