Provider Demographics
NPI:1114918489
Name:BAKER, STUART FLINT V (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:FLINT
Last Name:BAKER
Suffix:V
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2 MEMORIAL DR STE 310
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-3983
Mailing Address - Country:US
Mailing Address - Phone:217-877-9000
Mailing Address - Fax:217-877-9615
Practice Address - Street 1:2 MEMORIAL DR STE 310
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-3983
Practice Address - Country:US
Practice Address - Phone:217-877-9000
Practice Address - Fax:217-877-9615
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036060776208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036060776Medicaid
IL210924Medicare ID - Type Unspecified
IL036060776Medicaid