Provider Demographics
NPI:1205854999
Name:BAKER, WILLIAM VANCE (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:VANCE
Last Name:BAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:W
Other - Middle Name:VANCE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1040 S. 70TH ST.
Mailing Address - Street 2:TLS
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214
Mailing Address - Country:US
Mailing Address - Phone:414-476-9675
Mailing Address - Fax:414-615-0627
Practice Address - Street 1:1040 S. 70TH ST.
Practice Address - Street 2:TLS
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214
Practice Address - Country:US
Practice Address - Phone:414-476-9675
Practice Address - Fax:414-615-0627
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI239180202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30923800Medicaid
AB1172167OtherDEA NUMBER
WIF23310Medicare UPIN
WI30923800Medicaid
F23310Medicare UPIN