Provider Demographics
NPI:1164642955
Name:BAIRD, JOHN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:BAIRD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:MICHAEL
Other - Last Name:BAIRD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:501 MIRASOL CIR
Mailing Address - Street 2:SUITE 417
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5144
Mailing Address - Country:US
Mailing Address - Phone:502-370-5092
Mailing Address - Fax:
Practice Address - Street 1:3625 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4207
Practice Address - Country:US
Practice Address - Phone:904-399-6850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20827207V00000X, 208M00000X, 207P00000X
FL102656207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64208275Medicaid
KY7100102130Medicaid
KY000000527304OtherANTHEM
KY000000642738OtherANTHEM BCBS PROVIDER #
KY4611921OtherAETNA PROVIDER ID#
KY000000642738OtherANTHEM BCBS PROVIDER #
KY4611921OtherAETNA PROVIDER ID#
KY01232Medicare PIN
KY00386001Medicare PIN