Provider Demographics
NPI:1275696635
Name:R G BAKER DO PC
Entity Type:Organization
Organization Name:R G BAKER DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-383-5530
Mailing Address - Street 1:7226 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2060
Mailing Address - Country:US
Mailing Address - Phone:313-383-5530
Mailing Address - Fax:
Practice Address - Street 1:7226 ALLEN RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2060
Practice Address - Country:US
Practice Address - Phone:313-383-5530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30516671755360Medicaid
MI4204573Medicaid
MI30516581713306Medicaid
MI4120698Medicaid
MIE37408Medicare UPIN
MIH24935008Medicare ID - Type Unspecified
MI30516671755360Medicaid
MI4204573Medicaid
MIG97831Medicare UPIN
OH24935007Medicare ID - Type Unspecified
MI58200700011Medicare ID - Type Unspecified
MI58221425011Medicare ID - Type Unspecified