Provider Demographics
NPI:1467456301
Name:BAKER, MICHAEL ROGER (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROGER
Last Name:BAKER
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 1:595 CHAPEL HILLS DRIVE
Mailing Address - Street 2:STE 201
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920
Mailing Address - Country:US
Mailing Address - Phone:719-475-9613
Mailing Address - Fax:719-475-9539
Practice Address - Street 1:595 CHAPEL HILLS DRIVE
Practice Address - Street 2:STE 201
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:719-475-9613
Practice Address - Fax:719-475-9539
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38892207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO660003294OtherRR MCR
CO90102576Medicaid
COC5461Medicare PIN
CO90102576Medicaid