Provider Demographics
NPI:1255303590
Name:BAIBAK, LAURENCE MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:MATTHEW
Last Name:BAIBAK
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 1:12621 ECKEL JUNCTION RD STE 2400
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1304
Mailing Address - Country:US
Mailing Address - Phone:419-887-7000
Mailing Address - Fax:419-887-5701
Practice Address - Street 1:12621 ECKEL JUNCTION RD STE 2400
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1304
Practice Address - Country:US
Practice Address - Phone:419-887-7000
Practice Address - Fax:419-887-5701
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-059965208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0876922Medicaid
OH0876922Medicaid
OH0876922Medicaid